Every finding on record at Amedisys Hospice, L.L.C.

Upon patient record review, 4 of 27 (Patients 1,10,11, & 20) 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: Miralax was on medication profile with no evidence of instructions present for diluent. Patient 10: Senna is present on the medication profile with a dose range of "1-3" tablets by mouth TID. There is no evidence of clear instruction on when to administer dose of 1, 2, or 3 tablets. Patient 11: Atropine 1% ophthalmic drops are on medication profile 3-5 drops hourly for secretions with the "ophthalmic" route. There is no evidence of instruction on when to administer 3,4, or 5 drops. Also, there is no clarification found that drops should be administered orally for secretions rather than ophthalmic. Lorazepam is on medication profile with a range of 0.25ml -1ml with no evidence of clear instructions on proper dosing at the proper time. Miralax was on medication profile 6/22/23 with no instructions present for diluent. 6/22/23 MSIR 15mg initiated for pain. Pt. is also on Morphine Sulfate concentrate (1/23/23) for pain/SOB. There is no evidence of instructions on when it would be appropriate to utilize Morphine sulfate concentrate for c/o pain versus MSIR 15mg for pain. Senna is present on the medication profile with a dose range of "1-3" tablets by mouth TID. There is no evidence of clear instruction on when to administer dose of 1, 2, or 3 tablets. Patient 20: Medrol Dose Pack ordered on 3/10/23. Medication instructions state, "take per instructions on package" with no evidence of education or instruction on proper dosing.

Upon patient record review, 2 of 27 (Patients 4 & 6) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patients 4 & 6: the current aide POC has free text detail added, " any abnormal" in response to the care plan service, "Any observations to report to the RN/CM". There is no evidence of clarification of what would warrant reporting versus what the aide would be required to assess as abnormal. (Pt 4: POC 5/31/23 & Pt 6: POC 4/10/23).

Upon patient record review 1 of 27 (Patient #7) 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 7: every HHA visit had documentation of temperature as the only service provided. Aide POC in HCHB revealed the same. Per agency procedure, there was a copy of a written aide care plan initiated upon admit (by RN) with all services needed included. Staff verified CNA has been performing bathing and grooming per aide POC in home (paper copy in office). No evidence of complete aide documentation or reports of need to update HCHB POC to ensure appropriate documentation possible.

Upon patient record review 1 of 27 (Patients 5) did not have evidence in the patient record that the hospice aides report: • Changes in the patient's medical, nursing, rehabilitative, and social needs to a registered nurse, as the changes relate to the plan of care and quality assessment and improvement activities • Hospice aides must also complete appropriate records in compliance with the hospice's policies and procedures Patient 5: the 5/3/23 hospice aide noted pain rated 8 of 10 and patient LBM 4/29/23. The current hospice Aide POC indicates pain rated >4 should be reported to nurse and LBM> 3 days prior to be reported to RN. No evidence found of a report given to the nurse.