Every finding on record at B and A Hospice Inc

It is required that the hospice informs and distributes to the patient written information about its policies on advance directives, including a description of applicable state law. It is the patient’s right to formulate an advance directive should she or he wish to do so. The hospice maintains written policies and procedures concerning advance directives with respect to all adult individuals receiving care by or through the hospice. The hospice provides written information to patients about their rights under state law to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives at the individual’s option. The hospice updates and disseminates changes to state law on advance directives no later than 90 days from the effective date. This standard was not met as evidenced by clinical record review, document review and interview. 5 of 5 (100%) records reviewed revealed the hospice agency did not ensure patients who elected the hospice benefit received the agency's advance directives policy. Clinical Record #: 0, 1, 2, 3 and 4. Document 1: review of agency's admission packet failed to contain the written advance directive agency policy no. 1-004.1. A state specific advance directive form from a national member organization was located in admission packet. Staff 2: interview with the Director of Patient Clinical Services confirmed and agreed the agency's written advance directive policy was missing from the admission packet. Document 2: review of the agency's written policy titled Advance Directive Policy NO. 1-004.1 and addendum 1-004.A titled 'Advance Directive Information Statement' stated in part "...the organization recognizes that all persons have a fundamental right to make decisions relating to their own medical treatment....in the event of cardiac or pulmonary arrest, cardiopulmonary resuscitative measures will be promptly initiated unless a Do Not Resuscitate/Do Not Intubate order has been written by the physician in charge and documented in the patient's clinical record." The following policy was missing from the admission packet and not provided to patients or families.

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by a clinical record review and document review. 1 of 5 (20%) records reviewed revealed the hospice agency did not ensure an initial comprehensive assessment occurred within five (5) calendar days after the election of the hospice care by the patient. Clinical Record 3: the patient elected the hospice benefit on 6/17/2022 with the acceptance of skilled nursing and spiritual care services. A psychosocial assessment of the patient was not included in the registered nurse's initial assessment visit dated 6/17/2022 or within the 5 days of start of care. A skilled nursing visit to the patient on 06/22/2022 did not include the required elements of a psychosocial assessment per agency's policy. A spiritual care comprehensive assessment was completed on 06/21/2022. Agency policy no. 2-035.1 Psychosocial Assessment stated in part..."the psychosocial assessment will include, but not be limited to: (a) the patient's and family's attitude and emotional response to the terminal illness and treatment interventions, (b) the patient and family identification of drug and alcohol history, (c) a scale of psychosocial support, (d) a scale of coping styles and impact of illness on certain physical functions, (e) need for volunteer services to offer support or respite to the patient and family, (f) financial assessment...."

It is required that when controlled medications are first ordered, a copy of the hospice’s written policies and procedures for the management and disposal of controlled medications is provided to the patient or family or patient’s legal representative(s). The Interdisciplinary Group discusses the policies and procedures in a language and manner that the patient and family or patient’s legal representative understand and ensures that the safe use and disposal of controlled drugs is understood. This standard was not met as evidenced by clinical record review, document review and interview. 5 of 5 (100%) records reviewed of patients who elected the hospice benefit and received the agency's admission packet revealed the hospice agency did not ensure accurate policies and procedures on the management and disposal of controlled drugs were provided to patients. Clinical Record #: 0, 1, 2, 3 and 4. Document 3: review of agency's current drug disposal policy titled Home Use and Disposal of Controlled Substances Policy No. 3-005.1, was not equivalent to the drug disposal policy located in the agency's admission packet that was provided to the five patients and families admitted to hospice services. The policy stated in part that the hospice personnel will assist family to dispose of any patient medications when no longer needed. Document 1: review of the agency's admission packet which contained Policy 3-005.1 titled Home Use and Disposal of Controlled Substances stated in part…(8) "the hospice nurse, social worker or chaplain attending the death of a hospice patient will inform the family/caregiver of their responsibility to dispose of all the prescribed medication." The last section of the policy with header titled Disposal, stated in part "…a hospice nurse, accompanied by a witness, is responsible for disposing of the patient’s drugs in a manner consistent with State and Federal regulations. The admission packet policy contained contradicting processes of disposing controlled medication to the agency's current practice. Interview with Director of Clinical Services (Staff 2) stated the current drug disposal process was for the hospice staff to instruct the family on how to dispose of the medications and that hospice nurses did not destroy the medications. The Director of Clinical Services verified that the admission packet needed to be updated.