Every finding on record at Arkansas Hospice Inc

Based on clinical record review and staff interview, it was determined the Agency failed to include all medications utilized by the patient on the medication list in 1 (#2) of 12 (#2, #3, #4, #5, #6, #8, #9, #10, #11, #12, #13, #14) clinical records reviewed of patients utilizing oxygen. This failed practice by the Agency resulted in an inaccurate and incomplete clinical record and presented a risk to all patients on census currently utilizing oxygen as the failure to include all medications could potentially inhibit the patient's attending physician from making an informed decision regarding the patient's medication regimen related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. Findings follow: --- Review of clinical record #2 with a start of care of 06/29/24 revealed a patient with a diagnosis of Alzheimers Disease. On a form titled ";Visit Note Report" and dated 07/05/24 the Skilled Nurse documented the patient was currently utilizing oxygen. Review of a form titled "Client Medication Report" failed to include the medication Oxygen. There was no documentation in the chart to indicate that Oxygen had been checked for actual or potential drug interactions. An interview on 08/21/24 at 4:10 PM with Agency Personnel #1 and #2 confirmed that Oxygen was not included on the medication profile and not checked for actual or potential drug interactions.

Based on clinical record review and staff interview, it was determined the Agency failed to follow the physicians orders contained in the written plan of care in 1 (#6) of 14 (#1-#14) clinical records reviewed. This failed practice had the potential to affect all patients on current census and placed the patients and/or families at risk for adverse outcomes, ineffective care, and services due to a delay in coordination of information to meet the patients needs. Findings follow: --- Review of clinical record #6 with a start of care of 03/13/24 revealed a patient with a diagnosis of Multiple Sclerosis. Review of a document titled "Order Number: 349868" and dated 07/03/24 revealed "HOSPICE RECERTIFICATION" with a certification period of 07/11/24 to 09/08/24 and orders for Home Health Aide (HHA) services ";2Xs A WEEK AND PRN" (Twice a week and as needed). HHA visits missed weeks of 08/21/24-08/27/24 and 08/28/24-09/03/24. An interview on 08/22/24 at 9:30 AM with personnel #1 and #2 confirmed the missed HHA visits.

Based on clinical record review and staff interview, it was determined the Registered Nurse (RN) failed to supervise and assess the quality of care and services provided through on-site supervisory aide visits (SAV) every 14 days as required in 2 (#6 and #9) of 12 (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #12, #13) current clinical records reviewed with Hospice Aide (HA) services. This lack of supervision by the RN had the potential to place all patients receiving HA services at risk for adverse outcomes due to possible delays in the discovery of noncompliance with the aide plan of care by the HA or possible changes in the needs of the patient and family. Findings follows: --- Review of clinical record #6 with a start of care of 03/13/24 revealed a patient with a diagnosis of Multiple Sclerosis. Review of a document titled "Order Number: 349868" and dated 07/03/24 revealed "HOSPICE RECERTIFICATION" with a certification period of 07/11/24 to 09/08/24 and orders for HA services ";2Xs A WEEK AND PRN" (Twice a week and as needed). Documentation by the RN revealed SAVs were completed on 07/02/24 and 07/26/24 (10 days late). Review of clinical record #9 with a start of care of 07/29/23 revealed a patient with a diagnosis of Senile Degeneration of the Brain. Review of a document titled "Order Number: 351328" and dated 07/017/24 revealed an order type "HOSPICE RECERTIFICATION" with a certification period of 07/23/24 to 09/20/24 and orders for HA services ";5Xs A WEEK AND PRN" (Five times a week and as needed). On a document titled "Visit Note Report" and dated 08/05/2024 the RN documented a SAV. There were no other SAVs performed as of the record review date 08/20/24 (1 day late). An interview on 08/22/24 at 9:30 AM with personnel #1 and #2 confirmed the agency failed to conduct an aide supervisory visit within the required 14-day period.