Every finding on record at Citywide Hospice Care, Inc

Upon patient record review, 2 of 14 (Patient #5,#8) 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 5: The medication profile with entries for Santyl and Medi honey from discontinued wound care order. Current wound care order using mupirocin and calcium alginate dressing. Patient 8: Medication profile with duplicate entries for oxygen therapy, one entry includes flow at 2 liters per minute via nasal cannula as needed and another listed with liter flow as 2-5 liters per minute via nasal cannula as needed.

Upon patient record review, 2 of 14 (Patient #2,#5) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 2:The plan of care includes an order on admission for Nystatin to fungal rash. There is no evidence of problems, goals and interventions to manage a potential or active infection. Patient 5:The plan of care includes an order on admission for suction to be used as needed. There is no evidence of problems, goals and interventions for the use and safety of suction.

Upon patient record review, 1 of 14 (Patient #2) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 2:The medical record contains documentation that the patient is currently on anticoagulant therapy. There is no evidence that the aide plan of care includes bleeding precautions.