Every finding on record at Chestnut Hospice LLC

It is required that the hospice provides information on advance directives upon initiation of hospice care. Whether or not the patient has executed an advance directive is documented in a prominent part of the patient’s record. This standard was not met as evidenced by clinical record review and interview. 1 of 5 (20%) clinical records reviewed revealed that there was no clearly documented advance directive. Record #42000 was reviewed and identified the patient elected the hospice benefit on 1/31/2022. The Informed Consent completed on 1/31/2022 was marked by the patient as "I have an advance directive" but did not specify the type of advance directive out of the following provided choices: Living Will/Directive to Physician; Out of Hospital DNR or Medical Power of Attorney. In an interview on 5/11/2022, the Administrator confirmed that the patients choice for Advance Directive was not clearly documented in the clinical record. She had no additional information to provide.

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. The medication review process includes the identification of the following: The effectiveness of drug therapy; Drug side effects; Actual or potential drug interactions. 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. 2 of 5 (40%) clinical records reviewed revealed that the medication review did not capture all of required medications and did not document and of the potential side effects. Record #34270 was reviewed and identified that the patient elected the hospice benefit on 2/7/2022. The Initial RN Admission assessment completed on 2/7/2022 identified that Oxygen was ordered at 4LPM continuously. Review of the drug profile revealed Oxygen was not listed on the medication profile and not reviewed. Record #16830 was reviewed and identified that the patient elected the hospice benefit on 10/29/2021. Review of clinical documentation revealed that Oxygen was ordered on a RN visit on 11/9/2021. The medication was not present on the medication profile. Review of the drug profile revealed Oxygen was not listed on the medication profile and not reviewed. During an interview on 5/11/2022, the Adminnistrator confirmed the drug profiles ere not updated with the new medicaitons and there was no additional information to add.