Every finding on record at Aspirus at Home - Hancock

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The medication review process includes the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed it was revealed that the agency did not ensure that all medications were included in the patient's drug profile. Clinical Record 11: The record revealed a physician's order dated 03/26/2024 that read in part, "Oxygen at 2-4 liters via nasal cannula PRN dyspnea". The medication profile dated 03/26/2024 did not include oxygen. In an interview on 6/5/2024, the Administrator reviewed the record and stated, "The oxygen should have been on the medication profile".

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed of patients with aide services ordered, it was revealed that the agency did not ensure that all patient care instructions were accurate and included in the aide care plan. Clinical Record 17: The record revealed a physician's order dated 08/25/2023 that read "Oxygen 2 lpm via nasal cannula continuously.". The aide care plan dated 08/25/2023 lacked instructions regarding oxygen. Clinical Record 19: The record revealed a physician's order dated 03/12/2024 that read "Oxygen 2 lpm via nasal cannula as needed for dyspnea". The aide care plan dated 03/12/2024 lacked instructions regarding oxygen. On 06/04/2024, the Administrator reviewed the records and confirmed the findings.

It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident: Hospice medication information. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 3 (33%) home visit observations performed at a facility, it was revealed that the agency did not ensure that facility was provided all patient medication information. Clinical Record 1: The record revealed a physician's order dated 10/26/2023 that read in part, "Morphine sulfate solution 20mg/ml, give 10mg every 2 hours as needed for pain or dyspnea". Home Visit 1: During the home visit on 06/03/2024, the patient's medication record at the facility was reviewed with Personnel Record #1. The medication record dated 06/03/2024 did not include the medication morphine. Personnel Record #1 confirmed the finding and stated, "I am not sure why the morphine is not listed on the facility's medication record, but it should be". In an interview on 06/03/2024, the Administrator reviewed the record and stated, "The morphine should have been on the facility's medication record".

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. THIS IS A CONTINUING PRIOR REQUIRED ACTION. This standard was not met as evidenced by clinical record review and interview. 2 of 3 (66%) records reviewed of patients receiving aide services revealed that the agency did not ensure that written patient care instructions were prepared that would allow the aide to practice within the scope of practice. Clinical Record 5: The skilled nurse visit note dated 5/25/2023 read in part, "Oxygen was delivered, set up and administered via nasal cannula at 2L/min". The Home health aide plan of care was not updated and did not include oxygen. Clinical Record 2: The clinical record revealed orders for Oxygen 2L/min per NC PRN effective 11/12/22. The Aide Care Plan dated 12/16/22 did not include information to the aide related to oxygen. During interview on 5/30/2023 with the Clinical Supervisor, it was confirmed that the aide care plans were not updated to include oxygen. THIS IS A CONTINUED REQUIRED ACTION. 2 of 3 records reviewed with a home health aide revealed that the agency did not ensure that written patient care instructions were prepared that would allow the aide to practice within the scope of practice.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: Physician orders. This standard was not met as evidenced by clinical record review and interview. 1 of 5 (20%) clinical records reviewed revealed that the agency did not ensure that the clinical record contained all clinical information including physician orders. Clinical Record 5: The skilled nurse note dated 5/25/23 documented that oxygen at 2L per NC was initiated for the patient. There were no physician orders for oxygen found in the clinical record. The Supervisor stated in interview, "We have standing orders that we fax to the physician, we don't scan it in the chart until it is signed and sometimes it takes a while to get them signed". 1 of 5 (20%) of clinical records reviewed revealed that the agency did not ensure that the clinical record contained correct clinical information including physician orders.