Every finding on record at Family Hospice Care LLC

Based on observation, interview, and record review, the agency failed to ensure the medications listed in the patient's current medication profile and the Plan of Care (POC) were updated, accurate, and complete, for two of four patients reviewed (Patients 1 and 2) when: 1. For Patient 1, the medication Vitamin D (vitamin supplement) 2,000 IU (International Unit - a unit of measurement) 50 micrograms (mcg - a unit of measurement), was not listed in Patient 1's current medication profile and current POC; and 2. For Patient 2, a. The medication oxycodone (used to treat moderate to severe pain) 10 milligrams (mg - a unit of measurement), was listed in Patient 2's current medication profile and current POC, but not available for use; b. The medication morphine sulfate IR (immediate release) 15 mg (used to treat moderate to severe pain) was observed readily available for use but was not listed in Patients 2's current medication profile and current POC. These failures had the potential for Patients 1 and 2, and their primary caregivers (PCG) not to be able to identify the significant drug interactions, ineffective drug therapy and non-compliance with prescribed medications, and administration of medication not currently prescribed by the physician. --- Findings: 1. On July 24, 2023, Patient 1's record was reviewed. Patient 1 was admitted to the agency with the Start of Care (SOC) date of November 21, 2022, with diagnoses which included malignant neoplasm (cancerous tumor) of the right lung with metastasis (spread to other parts of the body) to the left lung and the bones. The Plan of Care (POC) for the certification period from May 21, 2023, through July 19, 2023, was reviewed. On July 25, 2023, at 9 a.m., a home visit was conducted for Patient 1 with Registered Nurse (RN) 1. Patient 1's family member was present during the visit. Patient 1 was observed lying on bed, awake, alert, and able to verbalize needs. Patient 1 was aware of the scheduled home visit and able to sign the hospice consent. Patient 1 stated her primary caregivers (PCG) were her family members. She stated she and her PCG managed her daily medications. On July 24, 2023, at 10:13 a.m., a concurrent interview and medication reconciliation review was conducted with Patient 1 and RN 1. One medication bottle with a label indicating Vitamin D 2,000 IU (50 mcg), take one tablet by mouth daily was observed. The medication was not listed in Patient 1's current medication profile and POC. Patient 1 stated she had been taking the Vitamin D for a while. RN 1 stated she was not aware Patient 1 was currently taking the Vitamin D supplement. She stated Vitamin D medication should be included in Patient 1's medication profile and POC. On July 26, 2023, at 2:50 p.m., a concurrent interview and record review was conducted with the Director of Patient Care Services (DPCS). The DPCS stated all medications should be included in the patients' medication profile and POC. She stated the Vitamin D 2,000 IU should have been listed in Patient 1's current POC and current medication profile. 2. On July 24, 2023, Patient 2's record was reviewed. Patient 2 was admitted to the agency with the Start of Care (SOC) date of February 9, 2023, with diagnoses which included heart failure and dementia (memory loss). The Plan of Care (POC) for the certification period from February 9, 2023 to May 9, 2023, and from May 10, 2023 to August 8, 2023, were reviewed. On July 25, 2023, at 12:54 p.m., a home visit was conducted with Registered Nurse (RN) 2 for Patient 2. Patient 2 resides in a Residential Care Facility for Elderly (FCFE) with 24 hours care. Patient 2 was observed lying in a hospital bed, awake and able to verbalize her needs. On July 25, 2023, at 2:18 p.m., a concurrent interview and medication reconciliation review was conducted with RN 2. During a review of Patient 2's medication profile the following were observed: - One medication oxycodone 10 mg , take one tablet po (by mouth) q (every) 8 (eight) hours for pain as needed, with a start date of February 27, 2023, was listed in Patient 2's current medication profile and POC, but was not available for use. RN 2 stated she was not aware the oxycodone 10 mg one tablet q 8 (eight) hours for pain was not available. RN 2 stated she could not recall when she performed the medication reconciliation with the RCFE staff. - One bubble pack containing 30 tablets of morphine sulfate IR 15 mg tablet with a written label indicating, "take 1 tablet by mouth every 4 hours prn (as needed) for pain or shortness of breath," dated 02/24/23 (February 24, 2023), was readily available for use, but was not listed in Patient 2's current medication profile and current POC. RN 2 stated the medication morphine sulfate IR 15 mg tablet was discontinued on March 29, 2023. RN 2 stated the medication should have been disposed when discontinued by the physician. RN 2 stated she was not aware the morphine sulfate IR medication was still available for use on Patient 2's medication basket containing the current prescribed medications. On July 26, 2023, at 2:45 p.m., a concurrent interview and record review was conducted with the Administrator and the DPCS. The Administrator and the DPCS acknowledged the medication oxycodone 10 mg tablet every eight hours prn for pain was still listed in Patient 2's current medication profile and current POC. The agency's visit note report dated March 29, 2023, indicated the licensed staff had received an order from the Nurse Practitioner (NP) to discontinue the order for morphine sulfate IR 15 mg tablet. The note also indicated the medication oxycodone 10 mg one tablet given every eight hours prn was use for breakthrough pain (the use of short-acting medication to relieve chronic pain). On July 27, 2023, at 8:42 a.m., the DPCS was interviewed. The DPCS stated the medication oxycodone 10 mg given every eight hours as needed should have been identified by the licensed staff when the medication was not available for use during medication reconciliation with the RCFE staff. She stated the morphine sulfate IR 15 mg tablet should have been disposed by the licensed staff with a consent from Patient 2's family member. She stated "there was no excuse" for the medication to be available for use when it was discontinued on March 29, 2023. The agency's policy and procedure titled, "Medication Reconciliation," dated May 10, 2023, was reviewed. The policy indicated, "...It is the policy of (name of hospice agency) to collect an accurate complete medication list on all patients upon admission to hospice. Medication Reconciliation is the process to determine the related status of medications to the hospice plan of care as well as whether medications should be continued or discontinued based on the plan of care...All hospice patient medications will continue to be reviewed during the IDG (Interdisciplinary Group - a group of healthcare professionals) process at a minimum of every 15 (fifteen) days...The RN Case Manager will review all of patient's prescription and over-the counter medications, herbal remedies and other alternative treatments that could affect drug therapy. The review will also monitor for medication effectiveness, actual or potential medication-related effects, duplicate drug therapy and untoward interactions..."

Based on observation, interview, and record review, the agency failed to ensure licensed staff follow and implement the safe use and disposal of controlled medication, for one of two patients reviewed (Patient 2), when Patient 2's morphine sulfate IR (immediate release) was not disposed after the order was discontinued by the physician on March 29, 2023. This failure resulted in having the controlled medication readily available for use, and increased the potential for medication error and may cause unusual side effects and drug interactions to Patient 2 and possibility of controlled medication diversion. --- Findings: On July 24, 2023, Patient 2's record was reviewed. Patient 2 was admitted to the agency with the Start of Care (SOC) date of February 9, 2023, with diagnoses which included heart failure and dementia (memory loss). The Plan of Care (POC) for the certification period from February 9, 2023 to May 9, 2023, and from May 10, 2023 to August 8, 2023, were reviewed. On July 25, 2023, at 12:54 p.m., a home visit was conducted with Registered Nurse (RN) 2 for Patient 2. Patient 2 resides in a Residential Care Facility for Elderly (RCFE). Patient 2 was observed lying in a hospital bed, awake, and able to verbalize her needs. On July 25, 2023, at 2:18 p.m., a concurrent interview and medication reconciliation review was conducted with RN 2. During medication reconciliation review of Patient 2's current medication profile and medications available being currently administered to Patient 2 by RCFE staff, one bubble pack containing 30 tablets of morphine sulfate IR 15 mg (milligram - unit of measurement) with a written label indicating, "take 1 tablet by mouth every 4 (four) hours prn (as needed) for pain or shortness of breath," dated 02/24/23 (February 24, 2023) was readily available for use, but was not listed on Patient 2's current medication profile and current POC. RN 2 stated the medication morphine sulfate IR 15 mg tablet was discontinued on March 29, 2023. RN 2 stated the medication should have been disposed when discontinued by the physician. RN 2 stated she was not aware the morphine sulfate IR medication was still available for use on Patient 2's medication basket containing the current prescribed medications. On July 24, 2023, at 2:20 p.m., RN 2 was observed performing drug disposal using the "Drug Buster" (a hard plastic container containing activated charcoal, which quickly neutralizes the active chemicals in pills and controlled medications). RN 2 was observed disposing 30 tablets of morphine sulfate IR 15 mg tablets to the drug buster container. The RCFE staff was present during the controlled drug disposal. On July 26, 2023, the agency's policy and procedure for controlled medication disposal was requested from the Director of Patient Care Services (DPCS). The agency's policy titled, "Controlled Medication and All Medication Disposal," dated June 6, 2023, was reviewed. The policy indicated, "...The family should be the one to dispose of the medication. With patient/family agreement, FHC staff can assist with the disposal of medications, in a manner that does not allow the drug to be unintentionally ingested or easily retrieved...If the family or caregiver refuses the destruction of the controlled medication the licensed nurse will document the refusal...If the patient/family agrees, the FHC licensed staff will assist with the disposal of controlled substances and all medications no longer needed...The drug destruction will be performed in the presence of a witness, after obtaining family consent. If family or facility staff is present, they will sign the witness field of drug disposal..." On July 27, 2023, at 8:42 a.m., a concurrent interview and record review was conducted with the DPCS. The DPCS stated RN 2 did not follow the agency's policy and procedure of controlled medication disposal for Patient 2's morphine sulfate IR 15 mg tablet when RN 2 disposed the medication on July 24, 2023, at the RCFE where Patient 2 resides. She stated RN 2 should have contacted Patient 2's family member (FM) before the disposal of the controlled medication. She stated RN 2 should have informed Patient 2's family member (FM) and should have asked permission for FM's agreement for the disposal of controlled medication. She stated if FM agreed, RN 2 should have offered assistance to dispose the morphine sulfate IR 15 mg tablets. She further stated RN 2 did not obtain the RCFE's staff signature as a witness for the disposal of controlled medication.