Every finding on record at Harmony Care Hospice, Inc.

Upon patient record review, 7 of 19 (Patients #1, 3, 4, 6, 8, 12, 13) 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 Patients #1, 3, 4, 6, 8, 12, 13: Medication profile contained oxygen continuous as needed. The order must state if it is continuous or as needed.

Upon patient record review, 9 of 14 (Patient #1, 2, 3, 4, 7, 8, 12, 13, 14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1: Patient is using a nebulizer for ordered nebulized medications. There is no evidence of interventions or goals for use of a nebulizer on the POC. Patient #2: The patient is prescribed aspirin as well as Eliquis. There are no interventions or goals for use of anticoagulants or bleeding precautions in the POC. The patient has type 2 Diabetes listed as related to terminal diagnosis. There is no evidence of interventions or goals for endocrine, including medications or signs and symptoms of high or low glucose. The patient has significant edema and is on diuretics. There is no evidence of interventions or goals for edema in the POC. The patient has oxygen ordered, however, there is no evidence of interventions or goals for oxygen in the POC. Patient is using a nebulizer for ordered nebulized medications. There is no evidence of interventions or goals for use of a nebulizer on the POC. Patient #3:The patient is taking aspirin. There is no evidence of interventions or goals related to use of anticoagulants or bleeding precautions. Patient #4: Patient is using a nebulizer for ordered nebulized medications. There is no evidence of interventions or goals for use of a nebulizer on the POC. Patient #7: The patient is taking aspirin. There is no evidence of interventions or goals related to use of anticoagulants or bleeding precautions. The patient is a full code. There is no evidence of interventions or goals related to advanced directives and code status. Patient #8: The patient is a full code. There is no evidence of interventions or goals related to advanced directives and code status. Patient #12: The patient is taking aspirin and Plavix. There is no evidence of interventions or goals related to use of anticoagulants or bleeding precautions. Patient #13: The patient is a full code. There is no evidence of interventions or goals related to advanced directives and code status. Patient #14: The patient is a full code. There is no evidence of interventions or goals related to advanced directives and code status.

Upon patient record review, 14 of 19 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients #1-14: There were orders on patient record for 30 PRN nursing visits. This was across the board showing no evidence of ordering services specifically to meet each patient and family needs.

Upon patient record review, 7 of 19 (Patient #1, 3, 4, 6, 8, 12, 13) 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. Patients #1, 3, 4, 6, 8, 12, 13: Oxygen orders were written as Oxygen continuous as needed. The order must state if it is continuous or as needed.

Upon client record review, 2 of 19 (Patient #1, 3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The patient has a G-tube. There is no order for the G tube site care being completed by hospice nurse(s). Patient #3: During the home visit. The dressing to the left heel was changed. The order called for Medi honey to wound bed followed by Silver alginate then rolled gauze. The RN used Calmoseptine rather than Medi Honey. Patient #11: The patient has a colostomy. There is no evidence of orders for colostomy care in the record and the hospice nurse(s) were performing colostomy care.

Upon client record review, 2 of 19 (Patients #15, 16) did not have evidence that the discharge summary includes all required information. Patient 15 and 16: There was no evidence that the discharge summaries contained a summary of the patients stay, including treatments, symptoms and pain management.

Upon patient record review, 1 of 14 (Patient #1) 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 #1, during the home visit that the patient was noted to be taking Vitamin D, Clopidogrel, Amlodipine, Amitriptyline, Atorvastatin, Carvedilol, hydralazine, escitalopram, pantoprazole, ondansetron, lisinopril, metoprolol. These medications were not on listed on the medication profile. This was corrected on site.

Upon patient record review, 1 of 14 (Patient #1) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1, during the home visit the patient had a POLST form that reflected the patient being a full code. When reviewing the patient record, the plan of care noted that the patient was a DNR. This was corrected on site.

Upon patient record review, 1 of 14 (Patient #1) 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 #1, during the home visit that the patient was noted to be taking Vitamin D, Clopidogrel, Amlodipine, Amitriptyline, Atorvastatin, Carvedilol, hydralazine, escitalopram, pantoprazole, ondansetron, lisinopril, metoprolol. These medications were not on listed on the plan of care. This was corrected on site.