Every finding on record at Asian Network Hospice, Inc.

Based on interview and record review, the hospice agencys licensed staff did not review the medication profile for one of 16 sampled patients (Patient 15). The staff were aware Patient 15 was taking over-the-counter (OTC) medications and did not identify potential drug interactions. This failure had a high probability of the OTC Chinese medication or supplement taken had a negative interaction and effect with the prescribed medications. Patient 15 was lethargic and unable to sit up in his wheelchair. --- Record review on 9/27/2023 at 11:18 a.m. of the Plan of Care Order dated 7/11/2023 showed Patient 15s benefit period was 7/7/2023 to 10/4/2023. The diagnoses included a stroke. Patient 15 was identified as a "Risk for Falls" and for staff to ";Assess for weakness and/or fatigue." Record review of the ";RN Initial Assessment," dated 7/7/2023 showed Patient 15 was alert, fully responsive and was ";...able to take a few steps with (his) cane and one person assistance..." Record review of the ";Skilled Nursing Visit(s)" showed the following: 7/9/2023 visit: Patient was oriented to person, place and had eaten breakfast in his wheelchair that morning. 7/10/2023 visit: Patient was described as alert and able to say the nursing staffs name. Patient 15 was ";Able to sit up in wheelchair for about 8-9 hours a day." 7/12/2023 visit: Patient 15 was ";Falling asleep and sliding in chair due to trunk weakness. Patient able to say few words with a lot of verbal cues from wife." Record review of the document, ";Skilled Nursing SOAP (subjective, objective, assessment, plan) Visit" dated 7/13/2023, showed Patient 15s wife reported she gave him ";5 pills of Chinese OTC medication to dilate the cardiac (heart) blood vessels..." and he became very lethargic. The wife stated this had happened before. There was no documentation in the clinical record which showed licensed nursing staff discussed the importance of potential negative interactions when taking OTC medications along with prescribed hospice medications. In an interview on 9/27/2023 at 11:33 a.m., the Agencys Clinical Manager (CM) stated staff had looked at the OTC medication but the ingredients were in Chinese and they didnt know what it was. CM stated it is important for staff to find out exactly what the medication is and to review with the family any potential negative interactions with regularly scheduled prescribed medications. Record review of the ";Administration and Documentation of Medications," (not dated) showed the purpose was to ";Identify medication administration circumstances. The Assessment Process includes a drug history and a comparison between the physicians orders and the current medications the patient is taking. Hospice personnel report discrepancies or contradictions to the physician for resolution."

Based on interview and record review the hospice agencys licensed nursing staff did not monitor the urinary output of one of 16 sampled patients (Patient 14). Patient 14s urinary catheter was removed. Staff did not monitor the output following the catheters removal as ordered by the doctor. This resulted in unnecessary bladder distention and the need for an urgent catherization. --- Record review of the ";Plan of Care Order," dated 9/13/2023 showed Patient 14s current benefit period was 9/9/2023 to 12/7/2023. The diagnoses included kidney disease. Patient 14 was described as ";incontinent" (unable to control bladder) and had a Foley catheter (tube into the bladder which drains urine into a bag) for urinary retention (unable to urinate which causes distention of the bladder). Record review of the ";RN (registered nurse)-Skilled Nursing Visit(s)" showed the following: 9/10/2023: Foley in place from the hospital. 9/12/2023: The RN called the doctor because the family and patient wanted the catheter removed. ";MD agreed to its removal but instructed if the patient doesnt void (urinate) within 24 hours, it should be reinserted." 9/15/2023: Patient 14 was described as ";incontinent." There was no documentation which assessed the amount Patient 14 had urinated since the catheter was removal on 9/12/2023. In an interview on 9/27/2023 at 12:40 p.m., the agencys Clinical Manager (CM) stated, ";incontinence" meant the patient had been urinating but it does not describe how much. CM stated staff should be asking the caregivers how many wet diapers Patient 14 had gone through over the previous day. CM confirmed there was no documentation in the visit notes indicating how often Patient 14 had been urinating or assessed for signs of a distended bladder. Record review of the document, ";Skilled Nursing SOAP (documentation tool which stands for subjective, objective, assessment, plan) Visit" dated 9/17/2023, showed Patient 14s bladder was distended and she had not been urinating. Nursing staff reinserted the catheter and immediately drained 300 milliliters (10 ounces) of urine. In an interview on 9/27/2023 at 3:07 p.m., Registered Nurse 1 (RN 1) confirmed during her visit on 9/15/2023 she had neglected to confirm Patient 14s urinary status. She stated tracking the number of wet diapers would indicate how much Patient 14 had been urinating in order to avoid bladder retention.

Based on interview and record review, the hospice agencys licensed nursing staff did not report a change in condition for one of 16 sampled patients (Patient 16). Patient 16s urine changed and staff did not notify the doctor. This resulted in a decrease in urine output, bladder distention and potential for the development of a urinary tract infection. --- Record review of the ";Plan of Care Order" dated 7/2/2023 showed Patient 16s benefit period was 7/2/2023 to 8/30/2023. The diagnoses included dementia (memory problem). Patient 16 had a urinary catheter (tube in the bladder which drains urine into a bag). A goal for Patient 16 was that he ";...will not have complications from urinary catheter." Record review of the ";RN (registered nurse) Recertification," dated 8/31/2023, showed Patient 16s urine was described as ";cloudy" without any odor, sediment or blood. Review of the ";RN-Skilled Nursing Visit," dated 9/4/2023, showed Patient 16s urine was cloudy and had developed an odor. There was no documentation which showed the doctor had been notified. Review of the nursing visit on 9/7/2023 showed Patient 16s urine continued to be cloudy with an odor. There was no documentation in the visit note which showed the doctor had been notified. In an interview and concurrent record review, on 9/27/2023 at 10:48 a.m., the agencys Clinical Manager (CM) confirmed there had been a change in the urine and staff did not notify the doctor. Record review of the ";Skilled Nursing SOAP (documentation tool for subjective, objective, assessment, plan) Visit," dated 9/8/2023, showed Patient 16 had no urine in the catheter bag and his bladder area was ";Bulgy (protruding)." The licensed nursing staff replaced the Foley catheter and ";Dark, cloudy urine flowed out with a lot of sediment." The doctor was notified and Patient 16 was prescribed antibiotics. In an interview on 9/28/2023 at 10:05 a.m., Registered Nurse 2 (RN 2) stated he had not called the doctor when the urine (color and bladder area) had changed. RN 2 stated the change in the characteristics of the urine could be a sign of a urinary tract infection. Record review of the document, ";Monitoring Patients Response Reporting to Physician," dated 5/4/17 showed, ";The patients physician is contacted whenever any of the following occur: Changes in the patients condition..."