Every finding on record at Avra Hospice Inc.

Upon patient record review, 5 of 14 (Patient #2,4,5,6,7) 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 #2-Medication profile dated 03/31/25 includes orders for Acetaminophen 650 mg rectal suppository q 4 hours as needed for fever. Acetaminophen 325mg, 2 tabs q 6 hrs prn pain and fever. The medication profile does not specify a maximum dose of Acetaminophen within 24 hrs. #4-Medication profile dated 03/18/25 includes Benefiber Gluten Free 3gm-4mg powder, take 5gm and mix with liquid, 2 tsps orally daily in am. There are no directions for how much liquid to use for reconstitution. Additionally, the dosage is unclear. The order mentions both grams, milligrams and teaspoons. #5-Medication profile dated 04/24/25 includes Diclofenac Sodium 1% Topical Gel, 4xdaily for pain. There is no location indicated for application. #6-Medication profile dated 03/24/25 includes Polyethylene Glycol 3350 17g powder for solution, 1 powder daily as needed for constipation. There are no instructions for reconstitution. #7-Medication order dated 04/11/25 for Alka Seltzer tablet, 2 tabs oral every 4 hours as needed for heartburn or indigestion. There is no order for dissolving the tablets in liquid. Medication order dated for 03/04/25 for Lorazepam 2mg/ml, give .25ml q2 hrs prn agitation. Additional order obtained on 03/05/25 for Xanax 0.5mg twice daily as needed for anxiety. There is potential for duplication of drug therapy with two anxiolytics and no communication or orders to address this issue.

Upon patient record review, 5 of 14 (Patient #2,4,5,6,7) 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. #2-Plan of care dated 03/31/25 includes orders for Acetaminophen 650 mg rectal suppository q 4 hours as needed for fever. Acetaminophen 325mg, 2 tabs q 6 hrs prn pain and fever. The medication profile does not specify a maximum dose of Acetaminophen within 24 hrs. #4-Plan of care dated 03/18/25 includes Benefiber Gluten Free 3gm-4mg powder, take 5gm and mix with liquid , 2 tsps orally daily in am. There are no directions for how much liquid to use for reconstitution. Additionally, the dosage is unclear. The order mentions both grams, milligrams and teaspoons. #5-Plan of care dated 04/24/25 includes Diclofenac Sodium 1% Topical Gel, 4xdaily for pain. There is no location indicated for application. #6-Medication profile dated 03/24/25 includes Polyethylene Glycol 3350 17g powder for solution, 1 powder daily as needed for constipation. There are no instructions for reconstitution. #7-Medication order dated 04/11/25 for Alka Seltzer tablet, 2 tabs oral every 4 hours as needed for heartburn or indigestion. There is no order for dissolving the tablets in liquid. Medication order dated for 03/04/25 for Lorazepam 2mg/ml, give .25ml q2 hrs prn agitation. Additional order obtained on 03/05/25 for Xanax 0.5mg twice daily as needed for anxiety. There is potential for duplication of drug therapy with two anxiolytics and no communication or orders to address this issue.

Upon patient record review, 5 of 14 (Patient #4,9,11,13,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. #4,9,11,13,14-SC orders on the plan of care are for 1 x to assess. The chaplain assessment determined the need for 1 x monthly visits, but there is no order for the monthly visits that are being made.