Every finding on record at Amed Community Hospice Austin

Upon patient record review 1 of 19 (Patient #2) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient 2: Patient admitted on 11/12/25,initial spiritual assessment was completed12/24/25. There is no evidence that it was completed within 5 days.

Upon patient record review, 2 of 19 (Patient #3,4) 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 3: Current medication record dated 2/23/26 includes orders for Hydrocodone-Acetaminophen 10/325, take one tablet by mouth every 6 hour prn, acetaminophen tab 500 mg every 6 hours and acetaminophen 650mg suppository every 6 hours. There is no maximum daily limit for acetaminophen.. Lidocaine 5% topical ointment ordered per instructions, apply thin layer to affected area, order does not contain a site of application. Voltaren gel ordered per instruction, apply topically to affected area, order does not contain a site of application or amount to apply. Patient 4: Current medication record dated 2/23/26 includes orders for hydrocortisone cream per instruction, apply topically to affected area for pain and swelling. Order does not include a site of application or amount to be applied. The Medication record includes orders for Hydrocodone-Acetaminophen 60/325, take one tablet by mouth every 6 hour prn, Hydrocodone 5g/325mg every 6 hours prn and acetaminophen 650mg suppository every 6 hours. There is no maximum daily limit for acetaminophen.. Voltaren gel ordered per instruction, apply topically to affected area, order does not contain a site of application.

Upon patient record review, 2 of 19 (Patient #12,14) 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 12: Current medication record contains orders for Eliquis, there is no evidence of a risk for bleeding care plan. Patient 14: Current medication record contains orders for aspirin, there is no evidence of a risk for bleeding care plan.

Upon patient record review, 3 of 19 (Patient #3,4) 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 3: Current POC dated 2/23/26, includes orders for Hydrocodone-Acetaminophen 10/325, take one tablet by mouth every 6 hour prn, acetaminophen tab 500 mg every 6 hours and acetaminophen 650mg suppository every 6 hours. There is no maximum daily limit for acetaminophen.. Lidocaine 5% topical ointment ordered per instructions, apply thin layer to affected area, order does not contain a site of application. Voltaren gel ordered per instruction, apply topically to affected area, order does not contain a site of application or amount to apply. Patient 4: Current POC dated 2/23/26, include orders for hydrocortisone cream per instruction, apply topically to affected area for pain and swelling. Order does not include a site of application or amount to be applied. Hydrocodone-Acetaminophen 60/325 take one tablet by mouth every 6 hour prn, Hydrocodone 5g/325mg every 6 hours prn and acetaminophen 650mg suppository every 6 hours. There is no maximum daily limit for acetaminophen. Voltaren gel ordered per instruction, apply topically to affected area, order does not contain a site of application.

Based on interview and record review, the Agency failed to update the Plan of Care in that 4 of 14 (Patients #4, #8, #10 and #13) patients updated Plan of Care/Medication List contained medication discrepancies in what the patient had received and what was listed in the patient record. This failure places the patients at risk of a decline in their health status from the physician prescribing the wrong medications resulting in ineffective treatment and duplication of medications or drug interactions. --- Findings included: Review of the clinical record of Patient #4 revealed a start of care date of 03/21/2023 for a terminal diagnosis of Heart Failure. Further review of the clinical record of Patient #4 revealed a Plan of Care for the certification period of 03/21/2023 to 06/18/2023. Review of a skilled nursing visit note, dated 03/26/2023, documented by the Registered Nurse, read in part, ";Fentanyl 50 mcg patch is intact and changed out Q72H (Every 72 hours)..." The skilled nursing visit note was signed by the Registered Nurse, dated 03/28/2023. Review of the Medication Profile and updated Plans of Care for Patient #4, dated 03/29/2023, 04/12/2023, 04/26/2023 and 05/10/2023 did not include orders for Fentanyl. During an interview conducted with the Registered Nurse on 05/25/2023 at 2:11 PM, the Registered Nurse confirmed the medication profile or plans of care for Patient #4 did not include Fentanyl. The Registered Nurse stated Patient #4 was being administered Fentanyl patches for pain. Review of the clinical record of Patient #8 revealed a start of care date of 08/23/2022 for a terminal diagnosis of Senile Degeneration of the Brain. Further review of the clinical record of Patient #8 revealed a Recertification Plan of Care for the certification period of 03/30/2023 to 05/28/2023. Review of a skilled nursing visit note dated 03/31/2023 documented by the Registered Nurse read in part, ";CG had administered Morphine 1 mL prior to bath....Medications reconciled with daughter. Hydrocodone delivered." The skilled nursing visit note was signed by the Registered Nurse, dated 04/03/2023. Review of the Medication Profile and updated Plans of Care for Patient #8, dated 04/12/2023, 04/26/2023 and 05/10/2023 did not include orders for Hydrocodone or Morphine. During an interview conducted with the Registered Nurse on 05/24/2023 at 10:42 AM. The Registered Nurse acknowledged the Hydrocodone and Morphine was not on the medication profile of Patient #8. The Registered Nurse stated Patient #8 was taking Hydrocodone and Morphine and these medications are in the E-prescribing software system the Agency utilizes to receive medication orders from the Physician. Review of the clinical record of Patient #10 revealed a start of care date of 05/12/2023 for a terminal diagnosis of Heart Disease. Further review of the clinical record of Patient #10 revealed a Plan of Care for the certification period of 05/12/2023 to 08/09/2023. Review of a skilled nursing visit note, dated 05/13/2023 documented by the Registered Nurse, read in part, ";Indicate any pain medications used and the number of PRN doses for each over the past 24 hours: Fentanyl 25 mcg patches, Dilaudid 2 mg tablets." The skilled nursing visit note was signed by the Registered Nurse, dated 05/22/2023. Review of the Medication Profile and updated Plan of Care for Patient #10 dated 05/17/2023 did not include orders for Fentanyl and Dilaudid. During an interview conducted with the Registered Nurse on 05/24/2023 at 10:42 AM. The Registered Nurse acknowledged the Fentanyl and Dilaudid were not included on the medication profile or plans of care for Patient #10. The Registered Nurse stated Patient #10 was taking these medications and they are in the E-prescribing software system the Agency utilizes. Review of the clinical record of Patient #13 revealed a start of care date of 02/02/2023 for a terminal diagnosis of Malignant neoplasm of lower lobe, left bronchus or lung. Further review of the clinical record of Patient #13 revealed a Plan of Care for the certification period of 02/02/2023 to 05/02/2023. Review of a skilled nursing visit note, dated 02/16/2023, documented by the Registered Nurse read in part, ";It has been difficult for Patient #13 to swallow medications so Physician ordered Fentanyl 12 mg patches for pain...Fentanyl patch applied." The skilled nursing visit note was signed by the Registered Nurse, dated 02/16/2023. Review of the Medication Profile and updated Plan of Care for Patient #13 dated 02/15/2023 did not include orders for Fentanyl. An interview was conducted with the Registered Nurse on 05/24/2023 at 10:42 AM. The Registered Nurse stated that she was ";horrible" at updating the medication profile. The Registered Nurse stated that orders for medications were received through an E-prescribing software utilized by the Agency. The Registered Nurse stated that she had been oriented upon hire on updating the patients medication lists. An interview was conducted with the Administrator/Supervising Nurse on 05/25/2023 at 9:20 AM. The medication discrepancies located in the clinical record of Patients #4, #8, #10 and #13 were presented to the Administrator/Supervising Nurse. The Administrator/Supervising Nurse was unaware of the E-prescribing software system utilized by the Agency. The Administrator/Supervising Nurse stated that the medication profile was required to be updated whenever there was a change in medications. During an additional interview conducted with the Registered Nurse on 05/25/2023 at 2:11 PM, the Registered Nurse demonstrated the E-prescribing system the Agency utilized. The E-Prescriber Software System profile for Patients #4, #8, #10 and #13 were reviewed with the Registered Nurse. Fentanyl was observed to be included on the E-Prescriber Software System profile for Patients #4, #10 and #13. Hydrocodone and Morphine were observed to be included on the E-Prescriber Software System profile for Patient #8. Review of the Agencys policy and procedure manual revealed a policy titled ";Review and Revision of Patient Care," which read in part, ";Upon identifying that patient care needs have changes (according to the Hospice policy), adjustments to the care planning documents will be made as follows: B. IDT Plan of Care....D. Medication Profile....All written changes to the Plan of Care will be incorporated into the patients medical record as changes occur."

Based on record review and interview, the Agency failed to include advance directives in its clinical record for 2 of 14 patients (Patients #13 and #14) whose records were reviewed. This failure has the potential that agency staff may be unaware of advance directives that patients have in place and could result in patients' last wishes not being honored. --- Review of the clinical record of Patient #13 revealed a start of care date of 02/02/2023 for a terminal diagnosis of Malignant Neoplasm of Lower Lobe, Left Bronchus or Lung. Review of the skilled nursing visit note, dated 02/16/2023, documented by the Registered Nurse read in part, ";Husband signed OOH DNR. Husband asked for assistance with funeral arrangements. Chaplain has gathered information and provided options and support during my visit." The skilled nursing visit note was signed by the Registered Nurse, dated 02/16/2023. An interview was conducted with the Registered Nurse on 05/25/2023 at 2:18 PM. The Registered Nurse stated Patient #13 had an out-of-hospital DNR. An interview was unable to be conducted with the Social Worker who completed the initial assessment for Patient #14 as she no longer was employed by the Agency. An interview was conducted with the Administrator/Supervising Nurse on 05/25/2023 at approximately 2:00 PM. Documentation of the Out of Hospital Do Not Resuscitate for Patient #13 was requested for review. The Administrator/Supervising Nurse stated that she would review the clinical record of Patient #13 and look for this document. On 05/25/2023 at 2:13 PM, the Administrator stated that she was unable to locate a copy of the Out of Hospital DNR in the clinical record of Patient #13. The Administrator stated it was the Agencys policy to include a copy of Advanced Directives in the patients clinical records. Review of the clinical record of Patient #14 revealed a start of care date of 09/22/2023 for a terminal diagnosis of Parkinsons Disease. Review of the RN Hospice Start of Care visit note dated 09/22/2022, documented by the Registered Nurse read in part, ";Discussion of Patients Preferences Regarding Life-Sustaining Treatments and Hospitalization: DNR preference confirmed with patient DNR preference confirmed with caregiver/responsible party. Documented discussion about not having advance directives? (Family Member) states that she thinks patient has a DNR in his file cabinet. (Family member) will search for records." An interview was conducted with the Registered Nurse on 05/25/2023 at 4:21 PM. The Registered Nurse stated Patient #14 did have an OOH DNR. The Registered Nurse stated that she saw the OOH DNR. An interview was unable to be conducted with the Social Worker who completed the initial assessment for Patient #14 as she no longer was employed by the Agency. An interview was conducted with the Administrator/Supervising Nurse on 05/25/2023 at 4:28 PM . Documentation of the Out of Hospital Do Not Resuscitate for Patient #14 was requested for review. The Administrator/Supervising Nurse stated that she was unable to locate a copy of the Out of Hospital DNR in the clinical record of Patient #14. Review of the Agencys policy and procedure manual revealed a policy titled, ";Advance Directives," which read in part, ";If an Advance Directive is in place, the Hospice staff will request a copy for the patients record and the medical record will be ";flagged" appropriately. B. The Hospice staff will make every effort to obtain a copy of any patients Advance Directive and file this copy in the medical record. If the patient does not provide the Hospice with a copy, this will be documented in the patients medical record."