Every finding on record at Adena Hospice

Upon patient record review, 6 of 19 records reviewed (Patient #1, #4, #7, #9, #10, #12) 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 #1: During the home visit the medication administration record indicated the patient should be receiving Oxygen 2LPM via NC continuously. The patient was not wearing her oxygen, the concentrator was in the corner of her room in a stored capacity (it was dusty) along with a portable tank that was also dusty. The oxygen tubing was covered with dust and coiled under the concentrator. The patient confirmed she did not feel she needed oxygen. COS. Patient #4: During the home visit the medication administration record indicated the patient was taking Donepezil 10mg po daily for memory loss. There was no evidence of the medication in the home. The son confirmed she had not been taking this since her start of care to hospice on 3/20/24. COS. Patient #7: The MAR indicated NTG 1 tablet take every 5 minutes as needed for chest pain for a maximum of 3 doses. The MAR did not indicate what action should be taken if the chest pain is not relieved after the max dose is given. In addition, the record indicated to apply lidocaine one dose topically to the affected area every 4 hours as needed for pain. There was no evidence as to where to apply the lidocaine and how much to apply. COS. Patient #9: The MAR indicated Lidocaine 5% topical ointment apply a small amount to the affected area twice daily as needed for pain. There was no evidence as to where to apply the Lidocaine. In addition, Sodium Chloride 5% ophthalmic one drop 3 times daily for glaucoma was indicated. There was no evidence on the MAR as to which eye or eye(s) to administer the drops. COS. Patient #10: The MAR indicated zinc oxide 22% topical cream one application as needed twice daily for skin. There was no evidence as to where to apply the zinc. COS. Patient #12: The MAR indicated Nystatin 100,000 Units/gram topical powder small amount to the affected area twice daily as needed for skin rash. There was no evidence of the specific site location. COS.

Upon patient record review, 3 of 19 records reviewed (Patient #4, #7, #10) 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 #4: The record indicated a nurses communication note on 5/31/24 Nystatin Powder applied under Breast and left groin sprayed with Zinc, there was no evidence in the Physicians order for these medications. COS. Patient #7: The MD order for NTG indicated to take 1 tablet take every 5 minutes as needed for chest pain for a maximum of 3 doses. The MD order did not indicate what action should be taken if the chest pain is not relieved after the max dose is given. In addition, the record indicated to apply lidocaine one dose topically to the affected area every 4 hours as needed for pain. There was no evidence as to where to apply the lidocaine and how much to apply. COS. Patient #9: The MD order for Lidocaine 5% topical ointment indicated to apply a small amount to the affected area twice daily as needed for pain. There was no evidence as to where to apply the Lidocaine. In addition, Sodium Chloride 5% ophthalmic one drop 3 times daily for glaucoma was ordered. There was no evidence from the MD order as to which eye or eye(s) to administer the drops. COS. Patient #10: The MD order indicated zinc oxide 22% topical cream one application as needed twice daily for skin. There was no evidence as to where to apply the zinc. COS. Patient #12: The MD order indicated Nystatin 100,000 Units/gram topical powder small amount to the affected area twice daily as needed for skin rash. There was no evidence of the specific site location. COS.

Upon client record review, 1 of 19 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The record indicated the Chaplain Frequency ordered on 5/14/24 was for 2 x M. There was no evidence of two chaplain visits from 5/14/24 to 5/30/24.

Upon patient record review 1 of 19 records reviewed (Patient #11) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #11: The record indicated an MD order for the hospice aide on 4/1/24 for 2XW for 9W. There was no evidence of a second visit from 4/1/24 to 4/6/24.