Every finding on record at Mercy Hospice Inc.

Based on observation, record review, interview, and policy review, the facility failed to ensure staff disposed of controlled substances properly. This affected one (Patient #7) of eight sampled patients. Findings include: --- Review of the most recent medication list revealed Patient #7 has Ativan (anti-anxiety) ordered 0.5 milligrams (g) every four hours. During observation during a home visit on 12/13/22 at 1:35 PM, Staff B arrived for a visit for Patient # 7. Medications were reviewed with Staff B. Staff B revealed there were 66 tablets of Ativan 0.5 mg and the narcotic count was correct. Staff B stated there were Reglan pills that were in the Ativan bottle. Then Staff B stated there were four extra Ativan tablets during the medication count. Two of the Ativan tablets dropped on the floor during the medication review. Staff B did not dispose of the medications in the home and did not mention that she was going to dispose of the Ativan. Review of the skilled nursing note dated 12/14/22, completed by Staff B, documented the Ativan count was off by four tablets. Patient #7 is not using more than the amount prescribed. Patient #7's wife states she could have forgotten to document times given and was unsure of when this may have been. Staff B called and updated the physician on the discrepancy. No new orders obtained at this time. Patient #7's Reglan (anti-emetic) tablets, used for nausea were found in the Ativan bottle. Patient #7's wife admits he is not always taking his medications as prescribed; however, she denies putting them back in the bottles. Reminded Patient #7's wife not to rebottle medications and discussed with Patient #7 and his wife the importance of medication compliance. This has not been an issue previously. Physician notified of this as well. There was no documentation of how Staff B disposed of the two tablets of Ativan dropped on the floor. During interview on 12/15/22 at 3:30 PM via telephone, Staff B stated she disposed of the Ativan in kitty liter that she had in her car and that she did not make the physician aware. Staff B stated she should have documented the Ativan was disposed of in the kitty liter. During interview on 12/15/22 at 3:35 PM, Staff A stated Staff B should have documented that the Ativan was disposed of in the kitty litter. Staff A stated Staff B was asked to come to the hospice agency for a drug test. During interview on 12/15/22 at 5:06 PM, Staff A stated she talked to Staff B again in regard to the drug diversion Ativan. Staff B told Staff A that she took the Ativan to the car and put it in the kitty liter and brought the bag back in the patient's home, moistened the kitty litter, sealed the bag and then threw the bag in the trash in Patient #7's home. Review of the policy and procedure titled "Medication Disposal" revealed hospice will educate patient/family/caregiver on policy and procedures for the management and disposal of controlled drugs in the patient's home. Qualified hospice employees may safely dispose of unused controlled substances on site after the death of a patient, or when the controlled substances are expired, or no longer needed because the hospice patient's plan of care has been modified. The purpose is to define appropriate management and disposal of controlled substances. Disposal of controlled substances is including mixing prescription drugs with an undesirable substance, such as used coffee grounds or kitty litter, and putting them in impermeable, non-prescript containers, such as empty cans or sealable bags, will further ensure the drugs are not diverted. A member of the hospice patient's household may dispose of the patient's pharmaceutical controlled substances or the appropriate hospice employee in cases where an ultimate user has given permission to the hospice to dispose of the medication. The DEA encourages hospice agencies to assist their patient/famiies in disposing of controlled substances in accordance with applicable regulations. While education is paramount, hospice is encouraged to partner with authorized collections to promote or jointly conduct mail-back programs.