Every finding on record at Midwest Hospice LLC

Upon patient record review, 2 of 6 (Patient #2,#4) 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 2 and 4: On admission, the patients medication administration record with entry of oxygen profiled to be delivered at 1-4 liters per minute via nasal cannula. There is no evidence that instructions for titration of oxygen are included on the medication administration record. Corrected on site.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services. L536

Upon patient record review, 1 of 6 (Patient #2) 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 2: Upon admission, the patient's medical record includes documentation of a Stage 1 pressure ulcer to sacral area with wound care regimen ordered and oxygen in use at 1-4 liters per minute via nasal cannula. There is no evidence of problems, goals and interventions on the plan of care related to pressure ulcer management or oxygen therapy.

Upon patient record review, 2 of 6 (Patient #2,#4) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 2 and 4:Upon admission, the patient's plan of care includes order for oxygen at 1 - 4 liters per minute via nasal cannula. There is no evidence of instructions for titration on the plan of care. Corrected on site

Upon patient record review, 1 of 6 (Patient #4) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient 4: The medical record contained nursing documentation upon admission identifying use of oxygen continuously by patient. There is no evidence that oxygen concentrator, oxygen supplies or oxygen tanks are included in the plan of care.

Condition of Participation: Hospice Aide and Homemaker Services. L607

Upon patient record review, 1 of 6 (Patient #6) 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 6: Upon admission, the aide plan of care with task of shower/tub bath and complete/partial bed bath ordered every visit. Clean and file nails assigned with no frequency noted for provision of service.

Upon patient record review 2 of 6 (Patient #3,#6) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 3:The aide plan of care included assignments of shampoo hair and nail cleaning/filing assigned every visit. There is no evidence in the documentation of the aide visits on 7/26/23, 6/26/23, 6/28/23, 7/17/23, 7/19/23, 7/24/23 and 8/2/23 that the tasks were completed. Patient 6:The aide plan of care included assignments of shave, dangle/commode and soak feet nail every visit. There is no evidence in the documentation of the aide visits on 8/1/23, 7/12/23, 7/17/32, 7/25/23 that the tasks were completed.