Every finding on record at Medline Paradise Hospice, Inc.

Upon patient record review, 2 of 14 (Patient #4,#9) 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 4 and 9:The medication profile includes an entry for Miralax 17 gms daily as needed for constipation. There is no evidence that the entry includes the type and amount of diluent for the administration of the medication.

Upon patient record review, 2 of 14 (Patient #1,#3) 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:The medical record includes nursing documentation that the patient has a primary diagnosis of metastatic breast cancer, is at risk for aspiration due to difficulty swallowing and requires supplemental oxygen 2-5 liters per minute via nasal cannula for shortness of breath. There is no evidence that the plan of care includes problems, goals and interventions for the management of the primary diagnosis of cancer, the management of the risk of aspiration and use and safety of oxygen. Patient 3:The medical record includes documentation that the patient has a primary diagnosis of atherosclerotic heart disease of the native coronary artery with angina pectoris. There is no evidence that the plan of care includes goals and interventions for the management of angina pectoris.

Upon patient record review, 1 of 14 (Patient #7) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 7:The medical record includes an order on 12/05/24 to discontinue oxygen use. There is no evidence of an update to the plan of care to remove problems, goals and interventions for the management and use of oxygen.

Upon patient record review, 1 of 14 (Patient #4) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 4:The aide plan of care includes the task of shower every visit and bed bath weekly. The patient is at risk for bleeding and anticoagulation precautions were not present on aide plan of care.