Every finding on record at Inspiring Hospice Partners of Oregon, LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; [and] other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measures are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #2-004 "Medication Profile" read in part, "Patients receiving medications administered by the hospice will have a current, accurate medication profile in the clinical record. The medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications. Upon admission to hospice, the admitting registered nurse will initiate a medication profile to document the current medication regimen." In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that the patient's current medications were included in the comprehensive assessment drug profile. Clinical Record 4: The patient elected hospice care on 08/22/2024 with a diagnosis of liver cell carcinoma. The initial plan of care dated 08/22/2024 through 11/20/2024 ordered: "Use oxygen as per physician order." The medication profile dated 08/22/2024 did not include documentation of oxygen. During an interview and a joint record review on 09/30/2024, the Executive Director confirmed the finding, stating, "There is no oxygen on this medication profile."

It is required that each patient’s individualized written plan of care: includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met, as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that the patient's plan of care included drugs and treatment necessary to meet the patient's needs. Clinical Record 4: The patient elected hospice care on 08/22/2024 with a diagnosis of liver cell carcinoma. The initial plan of care dated 08/22/2024 through 11/20/2024 ordered: "Use oxygen as per physician order." The plan of care did not include documentation of the flow rate, duration, and route of oxygen administration. During an interview and a joint record review on 09/30/2024, the Executive Director confirmed the finding, stating, "There is not an order for oxygen in this patient's chart."

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide; and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s needs. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records of patients with Hospice Aide services, the agency did not ensure that the Hospice Aide (HA) was supervised by a Registered Nurse (RN) no less frequently than every 14 days. Clinical Record 9: The patient elected hospice care on 08/22/2024 with a diagnosis of secondary malignant neoplasm of bone. The patient resided in an adult living facility (ALF). The physician's order dated 09/07/2024 ordered: "Aide services 2x per week." The HA supervisory visit was completed by the RN on 09/10/2024. A clinical record review revealed no further HA supervisory visits were documented as of 10/01/2024, with 21 days outstanding. During an interview and a joint record review on 10/01/2024, the Executive Director confirmed that aide supervision did not occur at least every 14 days.