Every finding on record at Best Support Hospice Inc.

Upon patient record review, 4 of 5 records (Patient #1,#2,#3,#5) 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. Patient 1: The medication profile contains Albuterol Neb 0.63/mg/3ml the medication dose is incorrect. The correct dosage on the label of albuterol is 0.021%/0.63mg/3ml. Corrected on site. Patient 2: The medication profile contains Ipratropium/albuterol 0.05mg/3mg/3ml. The dose is incorrect. The correct dosage on the label of Ipratropium/albuterol is 0.5mg/3mg/3ml. Corrected on site. Patient 3: The medication profile contains Ipratropium/albuterol 0.05mg/3mg/3ml. The dose is incorrect. The correct dosage on the label reads Ipratropium/albuterol 0.5mg/3mg/3ml. Corrected on site. The medication profile does not contain the Senna 8.6mg 1 QHS that was ordered on the plan of care. Corrected on site. Patient 5: The medication profile contains Ipratropium/albuterol 0.05mg/3mg/3ml. The dose is incorrect. The correct dosage on the label of Ipratropium/albuterol reads 0.5mg/3mg/3ml. Corrected on site. The medication profile contains Nystatin 10,000 unit/gm powder apply to bilateral breast area/groin area 2x a day as needed for rash or itching. There is no evidence of dose. Corrected on site.

Upon patient record review, 5 of 5 (Patient #1,#2,#3,#4,#5) 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. Patient 1,2,3,4,5: The care plan contains documentation under the Alteration in comfort R/T pain: Intervention: Instruct PCG on medications as ordered and assess proper use & effectiveness of medication (Fentanyl).There is no evidence of an order that patient is taking Fentanyl. Corrected on site. Patient 1: The plan of care contains Albuterol Neb 0.63/mg/3ml the medication dose is incorrect. The correct dosage on label of albuterol is 0.021%/0.63mg/3ml. Corrected on site. Patient 2: The plan of care contains Ipratropium/albuterol 0.05mg/3mg/3ml. The dose is incorrect. The correct dosage on label of ipratropium albuterol is 0.5mg/3mg/3ml. Corrected on site. Upon home visit there is evidence patient is on oxygen 2.5 liters nasal cannula. The plan of care does not contain an order for oxygen. Corrected on site. Patient 3: The plan of care contains Ipratropium/albuterol 0.05mg/3mg/3ml. The dose is incorrect. The correct dosage on label of ipratropium albuterol is 0.5mg/3mg/3ml. The plan of care contains an order for oxygen 2 liters/min for O2 sat less than 89%. Upon home visit finding, patient does not have oxygen or the need for oxygen. Both corrected on site. Patient 5: The plan of care contains Ipratropium/albuterol 0.05mg/3mg/3ml. The dose is incorrect. The correct dosage on label of ipratropium albuterol is 0.5mg/3mg/3ml. Corrected on site. The plan of care contains Nystatin 10,000 unit/gm powder apply to bilateral breast area/groin area 2x a day as needed for rash or itching. There is no evidence of dose. Corrected on site.

Upon patient record review, 5 of 5 records (Patient #1,#2,#3,#4,#5) 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 equipment and supply needs. Patient 1: Upon home visit, patient has a nebulizer for the albuterol treatments. The plan of care does not contain a nebulizer. Corrected on site. Patient 2: The comprehensive assessment includes documentation that patient is incontinent and wears briefs. There is no evidence of briefs being included on the plan of care. Corrected on site. Patient has oxygen in the home, there is no evidence of oxygen on plan of care. Corrected on site. Patient 3: Upon home visit, patient has a nebulizer for the ipratropium/albuterol treatments. The plan of care does not contain a nebulizer. Corrected on site. Patient 4: The comprehensive assessment includes documentation that patient is incontinent and wears briefs. There is no evidence of briefs being included on the plan of care. Corrected on site. Patient 5: Upon home visit, patient has a nebulizer for the ipratropium/albuterol treatments. The plan of care does not contain a nebulizer. Corrected on site.

Upon patient client record review, 3 of 5 records (Patient #1,#2,#3) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1,2,3: The care plan contains documentation by the RN under the Impaired Gas Exchange problem, a goal of: By the end of 2nd week, caregiver will be able to demonstrate proper tracheostomy care as evidenced by no evidence of infection, and other complications. There is no evidence the patient has a tracheostomy. Corrected on site.