Every finding on record at Monarch Hospice, Inc.

Upon patient record review, 2 of 11 (Patient #6, 7) 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. Patient #6- The medication profile included diclofenac gel 1% the location to be applied was not indicated. Patient #7- The medication profile included lidocaine 4% topical apply to affected area. The location to be applied was not specified.

Upon patient record review, 2 of 11 (Patient #6, 7) 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 #6- The plan of care included diclofenac gel 1% the location to be applied was not included. Patient #7- The plan of care included lidocaine 4% topical apply to affected area. The location to be applied was not specified.

Upon patient record review, 1 of 4 applicable (Patient #3) 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 Patient #3- The POC dated 5/9/22 included orders for aide 2 x week. The aide plan of care prepared by the RN indicated 1 x week. There was evidence that the aide provided 2 visits per week. The patient was on an anticoagulant and bleeding precautions were not indicated on the aide plan of care.

Upon patient client record review, 1 of 11 (Patient #5) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #5- The SN visit notes dated 3/19/22-5/24/22 did not specify the wound care that was performed only included "wound care performed".