Every finding on record at Hospice Preferred Choice, Inc.

Upon patient record review, 6 of 19 (Patient #1, #2, #5, #7, #11, #13) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient #1-The medication profile includes Haloperidol 2mg/ml .5ml q2h for agitation. The correct orders were for Haloperidol 2mg/ml .5ml q2h as needed for agitation. The medication profile includes multiple prn medications listed as follows for pain without differentiation for administration: Oxycodone 10mg 1 q4-6 h prn pain; Acetaminophen 650 mg rectal suppository q4h prn pain; and Hydrocodone-Acetaminophen 7.5mg/325 mg tab q4h prn pain. (corrected on site) Patient #2-The medication profile includes multiple prn medications listed as follows for pain without differentiation for administration: Acetaminophen 650 mg rectal suppository 1 suppository q4h prn pain; Morphine 100mg/5ml 20mg/ml .25ml q3h prn pain; and Tramadol 50 mg q8h prn pain. Loperamide is listed on the profile as Loperamide 2mg capsule 1 capsule as needed prn diarrhea. Max capsule 8/24hr. The frequency of administration is not listed. (corrected on site) Patient #5-The medication profile includes Oxygen 1-5 lpm prn comfort. The profile does not include specific parameters for titrating Oxygen. (corrected on site) Patient #7-The medication profile includes multiple prn medications listed as follows for pain without differentiation for administration: Acetaminophen 325 mg 2 tabs q6h prn pain; Morphine 100mg/5ml 20mg/ml .5 ml q1h prn pain and Tramadol 50 mg 1 tab q6h prn pain. Oxygen is listed on the profile as 1-5 lpm prn comfort. The profile does not include specific parameters for titrating Oxygen. Aspirin dosage is listed as Aspirin 325 mg 1 tablet daily post surgical with special instructions after 6 weeks resume Aspirin 81 mg po qd (profile is not updated as 325 mg every day has been discontinued). (corrected on site) Patient #11-On 03/22/24 orders were received for Hyoscyamine, Bisacodyl suppository, Roxanol, Lorazepam, Prochlorperazine, and Haldol. These medications were not added to the medication profile. On 03/26/24 the nurse documents the patient is taking Milk of Magnesia. Milk of Magnesia is not on the medication profile. (corrected on site) Patient #13-The medication profile includes Oxygen 1-5 lpm prn comfort. The profile does not include specific parameters for titrating Oxygen. Tramadol 50 mg q6h scheduled for pain is on the profile. Tramadol was ordered as needed. Polyethylene Glycol 17 g/dose oral powder daily prn constipation is on the profile. The profile does not include a diluent. (corrected on site)

Upon patient record review, 6 of 19 (Patient #1, #2, #5, #7, #11, #13) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including specific orders for all medications and treatments. Patient #1-The plan of care includes multiple prn medications listed as follows for pain without differentiation for administration: Oxycodone 10mg 1 q4-6h prn pain; Acetaminophen 650 mg rectal suppository 1 q4h prn pain; and Hydrocodone-Acetaminophen 7.5mg/ 325 mg 1 tab q4h prn pain.(corrected on site) Patient #2-The plan of care includes multiple prn medications listed as follows for pain without differentiation for administration: Acetaminophen 650 mg rectal suppository 1 suppository q4h prn pain; Morphine 100mg/5ml 20mg/ml .25ml q3h prn pain; and Tramadol 50 mg q8h prn pain. Loperamide is listed on the plan as Loperamide 2mg capsule 1 capsule as needed prn diarrhea. Max capsule 8/24hr. The frequency of administration is not listed. (corrected on site) Patient #5-The plan of care includes Oxygen 1-5 lpm prn comfort. The plan of care does not include specific parameters for titrating Oxygen. (corrected on site) Patient #7-The plan of care includes multiple prn medications listed as follows for pain without differentiation for administration: Acetaminophen 325 mg 2 tabs q6h prn pain; Morphine 100mg/5ml 20mg/ml .5 ml q1h prn pain and Tramadol 50 mg 1 tab q6h prn pain. Oxygen is listed on the plan of care as 1-5 lpm prn comfort. The plan does not include specific parameters for titrating Oxygen. Aspirin dosage is listed as Aspirin 325 mg 1 tablet daily post surgical with special instructions after 6 weeks resume Aspirin 81 mg po qd (plan of care is not updated as 325 mg every day has been discontinued). (corrected on site) Patient #11-On 03/26/24 the nurse documents the patient is taking Milk of Magnesia. Milk of Magnesia is not listed in the plan of care. (corrected on site) Patient #13-The plan of care includes Oxygen 1-5 lpm prn comfort. The plan does not include specific parameters for titrating Oxygen. Tramadol 50 mg q6h scheduled for pain is listed on the plan of care. Tramadol was ordered as needed. The plan of care also includes Polyethylene Glycol 17 g/dose oral powder daily prn constipation. The plan of care does not include a diluent. (corrected on site)

Upon patient record review, 1 of 19 (Patient #12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #12- On 03/24/24 the nurse documents inserting a 16 Fr Foley catheter. There are no orders on record for catheter insertion. (corrected on site).

Upon patient record review, 4 of 19 (Patient #3, #10, #11, #12) did not have evidence in the patient record that hospice aide assignments and duties are: • Complete written patient care instructions for a hospice aide prepared by a Registered Nurse with all identified safety measures. Patient #3-The Aide Care Plan does not include skin breakdown precautions which was an identified safety measure. (corrected on site) Patient #10-The Aide care plan does not include bleeding precautions which is an identified safety measure. (corrected on site) Patient #11-The Aide care plan does not include bleeding precautions which is an identified safety measure. (corrected on site) Patient #12-The Aide care plan does not include PEG tube precautions which is an identified safety measure. (corrected on site)

Upon patient client record review, 5 of 19 (Patient #2, 4, #9, #10, #11) 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 #2-The 02/29/24 plan of care lists safety measures as Chemotherapy (error). (late entry correction on site) Patient #4-The 03/15/24 and 03/29/24 IDG documentation includes the patient is on Oxygen prn. The 03/21/24 nursing note also documents Oxygen is safely stored in the home. The documentation is in error as the patient is not on Oxygen. (late entry clarification/correction on site). Patient #9-The Aide is assigned to weigh the patient weekly. On 03/18/24 the Aide documented the patient weighed 2,050 pounds. The patients actual weight is around 205 pounds according to other documented weights on record. Patient #10-The 03/14/24 nursing documentation contains multiple illegible entries as follows: hiw they were all adooted; ery basally; he takes his meds at NOC; explained his cood and lung issues. Patient #11-The 03/07/24 nursing documentation contains multiple illegible entries as follows: Ejection fraction 55% ; on 05/12/20 threes (unclear). The nurse documented they believe COPD came from her wood working with urination stain(unclear). The nurse documents medications are administered by Facility nurses. The CTI also documents the patient resides in a LTC Facility. This documentation is inaccurate as the patient resides at home. The 03/07/24 plan of care lists functional limitations as Amputation. This is an error as the patient does not have an amputation. (late entry correction on site)

Upon patient record review, 1 of 19 (Patient #19) did not have evidence that the discharge summary includes all required information. Patient #19-The discharge summary only states the patient was discharged following IDG due to an extended prognosis. The discharge summary does not include a summary of the patient's stay, including treatments, symptoms and pain management.