Every finding on record at Day-By-Day Staff Relief, LLC

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; supplements; herbal remedies; [and] other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] drug therapy associated with laboratory monitoring. 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, interview, and observation. In 2 of 3 (67%) home visits observed, the hospice did not ensure the comprehensive assessment included a medication profile that included the patient's current medications. Home Visit 2/Clinical Record 2: The patient elected hospice care on 02/06/2023. A medication review was conducted during the home visit with the Medical Social Worker (MSW) on 09/28/2023. During the hospice medication profile review, the patient stated, "I don't take the Metoprolol 25 mg tablets anymore and haven't for some time." The most recent skilled nurse assessment dated 09/25/2023 documented in the medication assessment, "Are there any changes to the medication regiment... NO." The hospice medication profile was not updated to include documentation of the patient's current medications. Home Visit 3/Clinical Record 3: The patient elected hospice care on 07/27/2023. A medication review was conducted during the home visit with the Registered Nurse (RN) on 09/28/2023. The medication review revealed the patient was taking "Vitamin B1 100mg one tablet daily" and "Folic Acid 1mg one tablet daily." The hospice medication profile did not include documentation of the Vitamin B1 and Folic Acid. The most recent skilled nurse assessment dated 09/26/2023 documented in the medication assessment, "Are there any changes to the medication regiment... NO." There was no documented evidence that the review of the patient's medication regimen included Vitamin B1 and Folic Acid. During an interview on 09/29/2023, the Branch Director confirmed the medication profiles were not updated, and no further documented evidence was provided.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review and interview. In 1 of 4 (25%) clinical records reviewed of patients discharged from the agency, the hospice did not ensure that a discharge summary was sent to the patient's physician. Clinical Record 12: The patient elected hospice care on 06/30/2023 and revoked the election of hospice care on 07/16/2023. There was no documented evidence that a hospice discharge summary was sent to the physician. During an interview and a joint record review on 09/29/2023, the Interim Administrator confirmed the finding, stating, "The discharge summary was not sent."