Heartland Hospice Central Wisconsin

“Upon patient record review, 4 of 19 (Patient #6,#9,#10,#13) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient#6: During record review it was noted that the following 3 active orders were on patient medication profile: 1) acetaminophen 325mg take 1 three times a day - do not exceed 400mg from all sources in 24 hours. 2) acetaminophen 650mg take 1 daily - Do not exceed 1625mg from all sources in 24 hours. 3) hydrocodone 5mg - 325mg take 1 every 6 hours PRN - Do not exceed 3000mg from all sources in 24 hours. Each order contained a different do not exceed amount for acetaminophen. Also noted that nurse documentation on admit narrative indicates nurse ordered oxygen for this patient. There is no evidence of this on the MAR. It was confirmed with the nurse that patient is on continuous oxygen 1-3 lpm via nasal cannula. Patient#9: During record review it was noted that there are duplicate active orders on the MAR for acetaminophen 325mg take 2 three times a day. One order was dated for 2/3/26 and the other is dated 2/10/26. Patient#10: During record review it was noted that the medication profile contained glutose 15 40% oral gel. This medication was marked as No for PRN. However, the instructions for this medication state take as needed for low blood sugar. There is no evidence of a parameter of when to take for the low blood sugar. It was also noted that the medication profile contained Gvoke DFE 1 pack 1mg/0.2ml subcutaneous syringe. This medication was marked as No for PRN. However, the instructions for this medication state take as needed for low blood sugar. There is no evidence of a parameter of when to take for the low blood sugar. Patient#13: During record review the medication profile contains ClearLax 1 powder packet orally per day. However, there is no evidence of instructions for dilutant.”

“Upon patient record review, 3 of 19 (Patient #6,#8,#12) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient#6 and #8: During record review it was noted there is no evidence of an initial bereavement assessment being completed. Patient#12: During record review it was noted that patient was admitted to services on 1/11/25. However, the initial bereavement assessment was not completed until 1/21/25.”

“Upon patient record review, 2 of 19 (Patient #1,#2) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient#1: During record review it was that that there is no evidence of measurements to wound on right heel for the week of 1/25/26. This patient had nurse visits on 1/27 and 1/31. The nurse documented on 1/31 that the facility assessed the wound. Patient#2: During record review it was noted that there is no evidence of measurements or assessment of the coccyx stage II wound for the week of 1/25/26. This patient had nurse visits on 1/26, 1/28, and 1/30.”

“Upon patient record review, 5 of 19 (Patient #6,#8,#9,#10,#13) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient#6: During record review it is noted that the nurse documented in admit narrative that patient was ordered oxygen. There is no evidence that the POC contains problems with goals and interventions related to the the use and safety precautions of oxygen. It was confirmed that the patient is on continuous oxygen. Patient#8: During record review it is noted that the aide POC contains fall precautions and swallowing precautions. The nurse admit documentation also indicates these are issues for the patient. There is no evidence of goals with interventions related to these issues on the main POC. Patient#9: During record review it is noted that the aide POC contains seizure precautions. The patient is also taking anticonvulsant medication which is ordered daily. There is no evidence of goals and interventions on the POC for this issue. Patient#10: During record review it was noted that on multiple nurse visits the patient is continuing to have issues with +2 and +3 edema to bilateral lower extremities. Nurses also document implement the use of diabetic socks and educating on the appropriate use of these as well as importance of elevating the lower extremities to help with edema. There is no evidence of goals and interventions related to the lower extremity edema or the diabetic socks. Patient#13: During record review it is noted that the POC contains interventions stating the wound to inner buttock is to be cleaned, pat dry, and apply A and D ointment. There is no evidence that this wound is present and currently being treated. Upon further review, this intervention was not deactivated when wound was healed.”

“Upon patient record review, 3 of 19 (Patient #6,#10,#13) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient#6: The medical record contained an order for the following 3 active orders were on patient medication profile: 1) acetaminophen 325mg take 1 three times a day - do not exceed 400mg from all sources in 24 hours. 2) acetaminophen 650mg take 1 daily - Do not exceed 1625mg from all sources in 24 hours. 3) hydrocodone 5mg - 325mg take 1 every 6 hours PRN - Do not exceed 3000mg from all sources in 24 hours. Each order contained a different do not exceed amount for acetaminophen. Also noted that nurse documentation on admit narrative indicates nurse ordered oxygen for this patient. There is no evidence of an order for the oxygen. It was confirmed with the nurse that patient is on continuous oxygen 1-3 lpm via nasal cannula. Patient#10: The medical record contained an order for glutose 15 40% oral gel take as needed for low blood sugar. There is no evidence of a parameter of when to take for the low blood sugar. It was also noted that the medical record contained an order for Gvoke DFE 1 pack 1mg/0.2ml subcutaneous syringe Give subcutaneously as needed for low blood sugar. There is no evidence of a parameter of when to take for the low blood sugar. Patient#13: During record review the medical record contained an order for ClearLax 1 powder packet orally per day. However, there is no evidence of instructions for dilutant.”

“Upon patient record review, 5 of 19 (Patient #3,#6,#7,#11,#14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient#3: The medical record notes the patient was ordered a low air loss mattress for DME on the POC. There was no evidence of an order for a hospital bed included in the plan of care. Patient#6: The admit nurse documents ordering oxygen in her narrative. However, there was no evidence of orders for the DME included in plan of care. Patient#7: The nurse documents on 2/4/26 that patient ambulates with a walker. There was no evidence of orders for a walker included in the plan of care. Patient#11: It is noted that a nebulizer is ordered as DME on the plan of care. However, the patient is not ordered any medication for a nebulizer. Patient#14: It is noted upon review that the only supplies listed on the order for the plan of care is incontinent supplies. The aide POC documents patient using Broda chair, gait belt along with other DME items were being used by the patient in the home. There is no evidence of an order for these DME items: Broda chair, gait belt, mattress, bed, half rails, or overbed table on the plan of care.”

“Upon patient client record review, 1 of 19 (Patient #12) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient#12: During review of records it was noted that the chaplain frequency order on 11/11/25 initial POC read 1 “comp” for spiritual and emotional support. The abbreviation “comp” is not an approved abbreviation per agency policy.”