Every finding on record at Bridge Hospice Solano LLC

Upon patient record review, 10 of 19 (Patient 1, 2, 4, 6, 11, 12, 14, 17, 18 and 19) 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 Patient 1 medication profile includes "Acetaminophen 325 mg tab 2 tabs by mouth every 4 hours prn pain/fever and Acetaminophen 500 mg tab 1 tab twice daily" with no daily dosage limit not to exceed 4000 mg daily. Patient 2 medication profile includes “Acetaminophen 325 mg tab 2 tabs by mouth every 4 hours prn pain/fever and Acetaminophen 650 mg rectal supp 1 every 6 hrs prn fever” with no daily dosage limit not to exceed 4000 mg daily. Patient 4 medication profile includes “Acetaminophen 325 mg tab 2 tabs by mouth every 6 hours prn pain/fever and Acetaminophen 650 mg rectal supp 1 every 6 hrs prn fever” with no daily dosage limit not to exceed 4000 mg daily. Patient 6 medication profile includes “Acetaminophen 500 mg tab 1 tab by mouth every 6 hours prn pain/fever, Acetaminophen 650 mg rectal supp 1 every 6 hours prn and Acetaminophen 500 mg 1 tab by mouth twice daily” with no daily dosage limit not to exceed 4000 mg daily. Patient 11 medication profile includes “Tylenol PM Extra Strength 25mg-500 mg tab 1 tab by mouth at bedtime, Acetaminophen 650 mg supp 1 per rectum every 6 hours prn fever, Acetaminophen 325mg tab 2 tabs by mouth every 6 hours as needed pain and Hydrocodone 10mg-Acetaminophen 325mg tab 1 tab by mouth 4 times daily” with no daily dosage limit not to exceed 4000 mg daily.. Patient 12 medication profile includes “Acetaminophen 500 mg tab 1 tab by mouth every am and Acetaminophen 500 mg tab 1 tab by mouth daily”; duplicate drug therapy and “Acetaminophen 500 mg tab 1 tab by mouth every am, Acetaminophen 500 mg tab 1 tab orally every 6 hours prn pain, and Acetaminophen 650 mg supp 1 per rectum every 6 hours prn fever” with no daily dosage limit not to exceed 4000 mg daily.. Patient 14 medication profile includes “Acetaminophen 325 mg 2 tabs orally every 8 hrs prn mild pain and Acetaminophen 650 mg supp 1 per rectum every 6 hrs prn mild pain or fever” with no daily dosage limit not to exceed 4000 mg daily.. Patient 17 medication profile includes “Acetaminophen 500 mg tab 1 tab twice daily for pain, Acetaminophen ES 500 mg tab 1-2 tabs every 6 hours prn pain and Acetaminophen 650mg 1 supp per rectum every 6 hours prn fever” with no daily dosage not to exceed 4000 mg daily.. Patient 18 and 19 medication profile includes “Acetaminophen 650mg supp 1 per rectum every 6 hours prn fever and Acetaminophen 325 mg tab 2 tabs by mouth every 6 hours prn pain” with no daily dosage limit not to exceed 4000 mg daily.

Upon patient record review, 10 of 19 (Patient 1, 2, 4, 6, 11, 12, 14, 17, 18 and 19) 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 plan of care includes "Acetaminophen 325 mg tab 2 tabs by mouth every 4 hours prn pain/fever and Acetaminophen 500 mg tab 1 tab twice daily" with no daily dosage limit. Patient 2 plan of care includes “Acetaminophen 325 mg tab 2 tabs by mouth every 4 hours prn pain/fever and Acetaminophen 650 mg rectal supp 1 every 6 hrs prn fever” with no daily dosage limit. Patient 4 plan of care includes “Acetaminophen 325 mg tab 2 tabs by mouth every 6 hours prn pain/fever and Acetaminophen 650 mg rectal supp 1 every 6 hrs prn fever” with no daily dosage limit. Patient 6 plan of care includes “Acetaminophen 500 mg tab 1 tab by mouth every 6 hours prn pain/fever, Acetaminophen 650 mg rectal supp 1 every 6 hours prn and Acetaminophen 500 mg 1 tab by mouth twice daily” with no daily dosage limit. Patient 11 plan of care includes “Tylenol PM Extra Strength 25mg-500 mg tab 1 tab by mouth at bedtime, Acetaminophen 650 mg supp 1 per rectum every 6 hours prn fever, Acetaminophen 325mg tab 2 tabs by mouth every 6 hours as needed pain and Hydrocodone 10mg-Acetaminophen 325mg tab 1 tab by mouth 4 times daily” with no daily dosage limit not to exceed 4000 mg daily.. Patient 12 plan of care includes “Acetaminophen 500 mg tab 1 tab by mouth every am and Acetaminophen 500 mg tab 1 tab by mouth daily”; duplicate drug therapy and “Acetaminophen 500 mg tab 1 tab by mouth every am, Acetaminophen 500 mg tab 1 tab orally every 6 hours prn pain, and Acetaminophen 650 mg supp 1 per rectum every 6 hours prn fever” with no daily dosage limit not to exceed 4000 mg daily. Patient 14 plan of care includes “Acetaminophen 325 mg 2 tabs orally every 8 hrs prn mild pain and Acetaminophen 650 mg supp 1 per rectum every 6 hrs prn mild pain or fever” with no daily dosage limit not to exceed 4000 mg daily. Patient 17 plan of care includes “Acetaminophen 500 mg tab 1 tab twice daily for pain, Acetaminophen ES 500 mg tab 1-2 tabs every 6 hours prn pain and Acetaminophen 650mg supp 1 per rectum every 6 hours prn fever” with no daily dosage not to exceed 4000 mg daily. Patient 18 and 19 plan of care includes “Acetaminophen 650mg supp 1 per rectum every 6 hours prn fever and Acetaminophen 325 mg tab 2 tabs by mouth every 6 hours prn pain” with no daily dosage limit not to exceed 4000 mg daily..

Upon client record review, 1 of 19 (Patient 13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 13 plan of care included “Home health aide services for assistance with personal care, hygiene and ADL’s" with no initiation of home health aide services, no aide care plan, no frequency, and no visit notes.