Every finding on record at Memorial Hospice Services 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 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 a review of clinical records, interviews and observations. 1 of 3 (33%) home visits revealed the patient's over-the-counter (OTC) medications were not included on the drug profile. Home Visit #1 was reviewed and identified the patient elected hospice care on 8/25/2022. During the home visit conducted on 9/14/2022, review of the patient's medications with the caregiver revealed Tylenol and Levothyroxine were listed on the hospice plan of care drug profile dated 9/12/2022, however two over-the-counter medications were missing and not listed; multivitamin and Vitamin D3. During an interview and a joint record review on 9/14/2022, the Administrator confirmed the over-the-counter medications were missing from the drug profile . The missing medications were added on 9/15/2022 and were sent for signature to the medical director.

It is required that medical supplies and appliances related to the palliation and management of the patient’s terminal illness and related conditions are identified in the plan of care. This standard was not met as evidenced by a review of clinical records, document reviews and interviews. 4 of 5 (80%) records reviewed revealed the supplies provided by the hospice were not documented on the patient's plan of care.. Record #4 was reviewed and identified the patient elected hospice care on 8/17/2022. The RN initial assessment dated 8/17/2022 documented the patient "was incontinent of bowel and bladder, wearing diapers. The agency's admission form "Medical Supply and DME List" dated 8/17/2022, documented briefs, catheter supplies, chux pads, personal care supplies, wipes, wound care supplies, nutrition supplies and other supplies to be provided by the hospice. The plans of care dated 8/17/2022 and 8/29/2022 did not include supplies. Record #5 was reviewed and identified the patient elected hospice care on 8/25/2022. The RN initial assessment dated 8/25/2022 documented the patient's functional status as bedbound and incontinent of urine. The RN visits dated 8/29/2022, 9/5/2022, 9/12/2022 documented the patient's urinary incontinence. The agency's admission form "Medical Supply and DME List" documented briefs, chux pads, personal care supplies and wipes to be provided by the hospice. The plans of care dated 8/25/2022 and 8/29/2022 did not include supplies. Record #3 was reviewed and identified the patient elected hospice care on 8/18/2022. The RN initial assessment dated 8/18/2022 documented the patient wore pullups and was incontinent of bladder. The agency's admission form "Medical Supply and DME List" documented briefs, chux pads and wipes to be provided by hospice. The plans of care dated 8/18/2022 and 8/29/2022 did not include supplies. Record #2 was reviewed and identified the patient elected hospice care on 8/18/2022. The RN initial assessment dated 8/18/2022 documented the patient was incontinent of bowel and bladder. The agency's admission form "Medical Supply and DME List" documented briefs, chux pads and wipes to be provided by hospice. The plans of care dated 8/18/2022, 8/29/2022, and 9/12/2022 did not include supplies. The agency's policy "Durable Medical Equipment (DME) and Medical Supplies" stated in part, "Hospice Responsibility (C) the hospice registered nurse will upon admission and as needed...(2) obtain a physician order for all DME and Medical Supplies. (3) Document/update the plan of care with all DME and Medical Supplies." During an interview, the administrator confirmed the supplies were missing from the patients' plans of care during joint record review. The administrator updated the active patients' plans of care with the their respective supplies on 9/14/2022.

It is required that when controlled medications are first ordered, a copy of the hospice’s written policies and procedures for the management and disposal of controlled medications is provided to the patient or family or patient’s legal representative(s). The Interdisciplinary Group documents in the patient record that the policies and procedures for managing and disposing of controlled medications is provided and discussed. This standard was not met as evidenced by a review of clinical records, document reviews and interviews. 2 of 2 (100%) records reviewed of the patients that died on hospice services and were pronounced by the hospice registered nurse (RN), revealed the agency did not follow their documentation policy for the destruction of controlled substances. Record #4: The patient elected hospice care on 8/17/2022. The hospice RN pronounced the patient's death on 8/19/2022. The discharge death visit note dated 8/19/2022 documented the medications disposal of morphine and lorazepam, but did not include the strength or quantities of the disposed of medications as per the agency's policy. A family member was documented as the disposal witness. Record #1: The patient elected hospice care on 8/10/2022. The hospice RN pronounced the patient's death on 8/15/2022. The discharge death visit note dated 8/15/2022 documented the medications disposal of morphine and lorazepam, but did not include the strength or quantities of the disposed of medications as per the agency's policy. The medication disposal witnesses of two family members were documented. The agency's policy "Controlled Drugs-Safe Use and Disposal Policy," read in part, "Upon discontinuation of a controlled drug or after patient death, the hospice registered nurse (RN)…. can assist with the destruction of the controlled substance(s) in the home. The RN will document and record in the clinical record: (a) the drug name, strength, and quantity destroyed." During an interview on 9/13/2022, the administrator confirmed the hospice registered nurse assists families to destroy medications, and the medication strength and quantity destroyed were missing from the documentation during joint record review.