Every finding on record at Eden Hospice at the Inland Northwest, LLC

Upon patient record review, 3 of 14 (Patient #4,5,6) 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 4: MAR has "Morphine concentrate 100mg/5ml oral solution 5-10 mg every 4 hours PRN as needed for pain". No instructions listed as to what pain level to give 5 mg or 10 mg. Corrected onsite. Patient 5: MAR has "Polyethylene Glycol 3350 17 gram/dose oral powder daily PRN for constipation". No instructions listed on how to dilute powder before ingesting. Corrected on site. Patient 6: MAR has "Polyethylene Glycol 3350 17 gram/dose oral powder daily PRN for constipation" and "Lactulose 10G/15ml daily PRN for constipation". No instructions on either medication as to which medication for constipation to give first and which to use second. Corrected on site.

Upon patient record review, 3 of 14 (Patient #4,5,6) 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 4: Order reads "Morphine concentrate 100mg/5ml oral solution 5-10 mg every 4 hours PRN as needed for pain." No instructions listed as to what pain level to give 5 mg or what pain level to give 10mg. Corrected on site. Patient 5: Order reads "Polyethylene Glycol 3350 17 gram/dose oral powder daily PRN for constipation." No instructions listed on how to dilute powder before ingesting. Corrected on site. Patient 6: Order reads "Polyethylene Glycol 3350 17 gram/dose oral powder daily PRN for constipation" and "Lactulose 10G/15ml daily PRN for constipation" No instructions on either medication listed as to which medication for constipation to give first and which to use second. Corrected on site

Upon patient record review, 1 of 14 (Patient #11) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 11: Initial sympathy card/Initial letter should have been sent on 05/24/2023, no evidence that the letter was sent until 06/27/2023. Agency has policy with a 3 week grace period for the initial sympathy card/letter. Bereavement Services policy 9003.