Every finding on record at 365 Hospice LLC

Based on review of agency policies, clinical records (CRs) and interview with the agency administrator (EMP#1), it was determined agency failed to address patient's pain management by not providing access to the comfort kit in the home for one (1) of three (3) CRs reviewed. (CR #3) --- Review of policy titled, ' PATIENT SELF-ADMINISTRATION OF MEDICATION; Policy No: H:2-058.1 ' on September 29, 2022, at approximately 10:45 a.m. stated, " PROCEDURE: 1. The hospice Case Manager will provide an opportunity for the patient to administer his/her own medications. The medications listed at the time of initial and comprehensive assessments and updates will be considered part of the plan of care; 2. The Case Manager will .... C Assess the patient ' s ability to self-administer medications correctly and document the patient ' s response and understanding to teaching ...H. Instruct the patient and family/caregiver regarding safe storage of medications. Consideration should be given to the following: 1. Medications should be stored separately from other poisonous drugs and chemicals. 2. Medications should be removed from storage during instruction and administration times. 3. Medications should be kept out of the reach of children, pets and confused or disoriented patients. 4. The nurse will plan with the patient and family/caregiver for the safe therapeutic storage of drugs during the assessment process (Ex. Lockbox, pill planner) ... " Review of policy titled, ' SAFE/EFFECTIVE USE OF MEDICATIONS; Policy No: H:5-002.1 ' on September 29, 2022, at approximately 11:00 a.m. stated, " PROCEDURE: 1. As part of the comprehensive assessment, the patient and family/caregiver will be assessing as to their knowledge and skill required for safe and effective use of medications. 2. The components of the medication assessment used to determine patient and family/caregiver knowledge and skill related to medication administration will include, but not be limited to: A Name, dosage, route, duration, time and usage of medication intended use as well as expected actions of drug therapy. B Preparation, self-administration, and use of medication, including over-the-counter products ...G. Proper storage and expiration dating of medications ...K. Other information, as applicable. Safe storage of medication (Ex. Lockbox)... E. Instructing the patient and family/caregiver regarding safe storage of medications: 1. Medications should be stored separately from other poisonous drugs and chemicals. 2. Medication should be removed from storage during instruction and administration times ....4. The nurse will plan with the patient and family/caregiver for the safe, therapeutic storage of drugs during the assessment process (ex. Lockbox, pill planner) ... " Clinical record review on September 29, 2022 between approximately 10:30 a.m. to -1:00 p.m. revealed the following: CR# 3, SOC 8/31/22: Review of ' Skilled Nursing Visit Note ' from date of visit 9/3/2022 section, ' Narrative Notes ' states, " ...Upon my arrival to patient ' s home, I was greeted by many family members. [Patient ' s name] was sitting in her bed upright, eye rolled back and moaning in pain and distress. Patient ' s wife [Name] states they gave her the Dilaudid that is ordered every three hours. Was given two hours ago and pain is not being controlled I asked if they had the comfort meds and they said yes but they ' re in the lock box. They have no access to the lock box because it ' s locked. I read [EMP # 3] ' s notes and was able to open the lock box. I was embarrassed that the family has comfort medications in the home, but they were unable to access them. Patient was in extreme pain and family had no way of helping her. I apologized over and over. I gave her morphine and Ativan and within 30 minutes patient was resting comfortably and was sleeping. I called [EMP# 4, EMP# 5 and EMP# 6] to find out why there was a lock box in the house. No one could give me an answer because nobody understands why. I did ask the family if there were any issues with any addiction. They stated no. This is a very well-educated couple with a beautiful well-kept home ...I did call [EMP# 3] to let her know about the lockbox situation and she is in agreement to have the box removed from the home. " Interview with EMP # 1 on September 29, 22 at 1:00 p.m. confirmed above findings.