Every finding on record at Nest Home Hospice and Palliative Care LLC

Upon patient record review, 1 of 5 (Patient #1) 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 Patient 1: The medication list indicates polyethylene glycol 17g po daily for the management of constipation, but does not include instructions for the reconstitution of this powdered medication. (corrected onsite)

Upon patient record review and direct observation during the home visit, 2 of 5 (Patient #1, 3) 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 1: The patient requires the use of oxygen and related equipment, a wheelchair, and a nebulizer for management of the terminal illness; however, this DME does not appear on the plan of care. (corrected onsite) Patient 3: The patient requires the use of oxygen and related equipment and a hospital bed for management of the terminal illness; however, this DME does not appear on the plan of care. (corrected onsite)

Upon patient client record review, 1 of 5 (Patient #3) 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 3: The physician's certification of terminal illness, SN initial comprehensive assessment, all SN visit notes, and all IDG review updates indicate the patient's primary terminal diagnosis is congestive heart failure; however, the initial plan of care indicates the patient's primary terminal diagnosis is cancer of the stomach. The Director of Nursing verified that this was a documentation error.