Every finding on record at Envision Hospice of Colorado LLC

Upon patient record review, 2 of 19 (Patient #4, 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 Patient 4: The patient's oxygen did not appear on the medication list. (corrected onsite) Patient 8: The SN visit note dated 04.25.2023 indicated the use of Flagyl for odor control during wound care; however Flagyl did not appear on the medication list. (corrected onsite)

Upon patient record review, 2 of 19 (Patient #11, 12) 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 11, 12: The care plans for these patients utilized a standing order template related to the Foley catheter indicating Insert 14-20Fr Foley catheter with 5-30mL balloon, change monthly and PRN. This treatment order is overly broad, not individualized for each patient's needs, and does not have a specifier for the PRN indication. (corrected onsite)

Upon client record review, 2 of 19 (Patient #1 and 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: Orders for SN visits were written for 2 visits weekly, starting 04.15.2023 (Saturday); only 1 SN visit was made during the week of 04.15.2023. Patient 8: Various SN narrative chart entries related to wound care did not have a corresponding care plan order. This included the following: on 04.25.2023 the SN indicated the right chest wound was cleaned with soap and water, dressed with silver gel & crushed Flagyl, and covered with alginate strips; on 04.29.2023 the SN indicated the bilateral lower extremity wounds were covered with a 4" wide ACE bandage; on 05.08.2023 the SN indicated the left calf wound was cleaned with soap & water, patted dry, medihoney was applied, and then the site was covered with a bandage. The RN Case Manager was contacted and current wound care orders for all sites were clarified and entered into the care plan. (corrected onsite)

Upon patient record review 1 of 19 (Patient #2) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient 2: HA visits were decreased from twice weekly to once weekly starting the week of 4.09.2023; however, the HA continued to make visits on the schedule of twice weekly on April 10&13, 17&20, 25&28, and May 02&05. On discussing with the RN Case Manager, it was determined that the order should not have been decreased to once weekly and the patient requires ongoing assistance with ADLs. The HA care plan was updated to reflect the intended twice weekly HA orders.

Upon patient client record review, 1 of 19 (Patient #10) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 10: At the time of admission for hospice services. The patient/caregiver requested the Notification of Noncovered Services; however, there was no evidence this was returned by the agency within the 5 days allowable, or at any subsequent time.

Upon patient client record review, 1 of 19 (Patient #6) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 6: At the time of hospice admission on 01.04.2023, a MOST form was collected indicating the patient's preferences for full code/CPR status. The comprehensive nursing assessment and HIS questions were also completed to indicate these preferences. However, the toggle in the patient's EMR was inadvertently set to DNR, so that the banner bar on the patient's profile, medication list, etc. displays as DNR code status. (corrected onsite)