Every finding on record at Good Shepherd Hospice

Based on interview and document review the agency failed to develop a plan of care (POC) that included all prescribed medication for 1 of 1 patients (P10) whose medications were reviewed. --- P10's discharge summary dated 3/22/23, identified P10 was being discharged to hospice care. Discharge medications included probiotic daily (qd), Metamucil three times per day, simvastatin 20 milligrams (mg) by mouth (po) qd, warfarin (a blood thinner to prevent stroke) 2 mg po Sunday, Tuesday and Thursdays and 1 mg all other days, ciprofloxacin 250 mg po twice a day (BID), tamsulosin 0.4 mg po qd, hydroxyzine (for itch) 25 mg po qd, furosemide (a diuretic) 20 mg po BID, ensure po qd, fish oil po qd, vitamin D3 10 microgram (mcg) po qd, vit c po qd, mag glycinate 100 mg po qd, cranberry extract 200 mg po qd, digoxin (for heart) 125 mcg po qd, carvedilol (for heart and blood pressure) 1.5625 mg po BID and nitroglycerin 0.2 mg per hour patch qd. P10's plan of care (POC) identified a start of care (SOC) of 3/22/23. Diagnoses included vesicointestinal fistula (an abnormal connection between the bladder and intestine), dementia, mood disturbance, anxiety, persistent atrial fibrillation (abnormal heart rhythm), and heart disease. P10's primary terminal diagnosis was vesicointestinal fistula. Medications included as needed: roxanol (to relieve pain or shortness of breath), acetaminophen, bisacodyl suppository (to treat constipation), hyoscyamine sulfate (to treat secretions), lorazepam (to treat anxiety) and ondansetron (to treat nausea). No scheduled medications were listed. P10's skilled nurse visit note dated 3/22/23, identified P10 was admitted to hospice with various assessments completed. The visit documentation did not indicate medications were reviewed with P10's physician or pharmacist and did not identify medication changes were made from the discharge summary. The assessment note lacked any medication regimen review. During an interview on 5/10/23, at 11:15 a.m. hospice manager (HM) stated the agency received medication orders for new admissions with their clinic referrals or from a discharge summary if the patient was discharged from a hospital The admitting nurse reviewed all medications with the patient and family during the admission visit and compiled a medication list to review with the primary provider. The medications would be reviewed and a discussion on which medications the provider may want to discontinue due to the patient's terminal diagnosis and life expectancy. The revised medication list is what is recorded on the patient's POC. If the provider chooses to discontinue medications, a verbal order would be completed for the provider to sign. HM understood P10's medications were discontinued due to not taking them consistently. HM was not aware they were all documented on the discharge summary. A verbal order was not obtained to discontinue the scheduled medications listed on the discharge summary and P10's medical record lacked documentation that the medications were reviewed with the provider on admission. The agency's policy Medication Profile/Medication Regimen Review dated 5/2020, indicated at the time of admission the registered nurse would check all medications a client may be taking. Changes in medication orders would be documented in the medical record with a physician's signature obtained by telephone or verbal orders. The agency's policy Physician Orders dated 5/2020, indicated orders for medications and treatments must be updated whenever there is a change in medications or treatments.

Based on interview and document review, the agency failed to ensure the interdisciplinary group (IDG) conferred with an individual with additional education in drug management to ensure the drugs and biologicals meet each patient's needs for 1 of 1 patients (P10) reviewed for medications. --- P10's discharge summary dated 3/22/23, indicated P7 was being discharged to hospice care. Discharge medications included probiotic daily (qd), Metamucil three times per day, simvastatin 20 milligrams (mg) by mouth (po) qd, warfarin (a blood thinner to prevent stroke) 2 mg po Sunday, Tuesday and Thursdays and 1 mg all other days, ciprofloxacin 250 mg po twice a day (BID), tamsulosin 0.4 mg po qd, hydroxyzine (for itch) 25 mg po qd, furosemide (a diuretic) 20 mg po BID, ensure po qd, fish oil po qd, vitamin D3 10 microgram (mcg) po qd, vit c po qd, mag glycinate 100 mg po qd, cranberry extract 200 mg po qd, digoxin (for heart) 125 mcg po qd, carvedilol (for heart and blood pressure) 1.5625 mg po BID and nitroglycerin 0.2 mg per hour patch qd. P10's plan of care (POC) identified a start of care (SOC) of 3/22/23. Diagnoses included vesicointestinal fistula (an abnormal connection between the bladder and intestine), dementia, mood disturbance, anxiety, persistent atrial fibrillation (abnormal heart rhythm), and heart disease. P10's primary terminal diagnosis was vesicointestinal fistula. Medications included as needed: roxanol (to relieve pain or shortness of breath), acetaminophen, bisacodyl suppository (to treat constipation), hyoscyamine sulfate (to treat secretions), lorazepam (to treat anxiety) and ondansetron (to treat nausea). No scheduled medications were listed. P10's skilled nurse visit note dated 3/22/23, indicated P10 was admitted to hospice with various assessments completed. The visit documentation failed to identify if medications were discussed with P10 or his spouse. The visit documentation did not indicate medications were reviewed with P10's physician or pharmacist and did not identify medication changes made. The assessment note lacked any medication regimen review. P10's medical record lacked evidence that a physician or pharmacist reviewed P10's scheduled medications and/or made recommendations to discontinue P10's medication due to P10's terminal prognosis. The medical record lacked physician orders and rationale to discontinue P10's scheduled medications on his admission to hospice. The medical record lacked evidence P10 or his family was advised of the risks or benefits of discontinuing his prescribed scheduled medication. During an interview on 5/10/23, at 11:15 a.m. hospice manager (HM) stated the physician that discharged P10 from the hospital was not P10's primary provider and was not aware P10 was not taking his scheduled medications consistently. HM knew the primary providers preferred to make their own determination on what medications to discontinue when patients were admitted to hospice, so the agency did not utilize a pharmacist to review medications for new admissions. The agency reviewed all the patient medications directly with the provider instead. It was the agency's practice to write out a verbal order when discontinuing any patient medications after discussing it with the patient's primary provider. HM remembered P10's medications were reviewed with his primary provider and was not aware the scheduled medications were listed on P10's discharge summary, as he was no longer taking them. A verbal order to discontinue the medications was not completed. HM was unable to provide evidence P10's medication orders were reviewed directly with his provider on his admission to hospice on 3/2/23. The agency's policy Medication Profile/Medication Regimen Review dated 5/2020, indicated at the time of admission the registered nurse would check all medications a client may be taking. Changes in medication orders would be documented in the medical record with a physician's signature obtained by telephone or verbal orders.