Every finding on record at Northwest Hospice, LLC

Based on interview and medical record review, it was determined the hospice agency failed to confirm that communication with other health care providers participating in the provision of care for the terminal illness and related conditions and other conditions was disseminated effectively to ensure quality of care for the patient and family for 3 of 5 patient records reviewed (Patients #1, 2 and 5). Findings: Patient #1: Review of the medical record indicated Patient #1 was admitted on 4/2/2021. Demographic information indicated the patient lived in an adult foster home. Review of a Coordination Note, dated 4/6/2021, note type "TRIAGE," indicated a caregiver from the adult foster home called the hospice agency to "let us know they have not received medication refills that hospice covers." The note indicated that a call to the pharmacy revealed the pharmacy "did not have orders for patient nor do they have a current medication list." During an interview with Employee #1 and Employee #2 on 9/22/2021, beginning at 1:00 PM, Employee #1 acknowledged that patient information was not communicated in a timely manner and stated "Admission note documentation is late. Yeah, the admission notice is not in there until later." Patient #2: Review of the medical record indicated Patient #2 was admitted on 4/3/2021. Demographic information indicated the patient lived in a skilled nursing facility. Review of a Coordination Note, dated 4/15/2021, note type "NARRATIVE," entered by an agency LPN, indicated "This LN contacted [MD Name] for liquid [pain medication] order. Order entered into HCHB and 1 Point." Visit note documentation revealed this visit started at 4:42 PM. Review of a Coordination Note, dated 4/16/2021, note type "NARRATIVE," entered by an agency Chaplain, indicated "...Chaplin [sic] consulted with nurse [facility nurse Name], who said patient is spitting out [his/her] crushed medications and [he/she] needs liquid medication." Visit note documentation revealed this visit started at 12:12 PM. Review of a Coordination Note, dated 4/16/2021, note type "NARRATIVE," entered by an agency RN, indicated "PRN visit for pain crisis, reported by facility. Per phone message, patient not swallowing, spitting out crushed [pain medication] and liquid [antianxiety medication]. Liquid [pain medication] ordered yesterday(?) but not delivered. Phone call to [MD name] to confirm administration per rectum if unable to give PO. Meds ordered through wrong pharmacy. Straightened out, reordered through Propac..." The note later indicated "Inserted half tablet of [pain medication] into stoma after moistening it with water." Visit note documentation revealed this visit started at 7:31 PM. During an interview with Employee #1 and Employee #2 on 9/22/2021, beginning at 1:00 PM, both employees confirmed that the medication was originally ordered from the wrong pharmacy. Review of pharmacy record information presented by Employee #2 revealed the liquid pain medication was ordered from the correct pharmacy at 11:27 AM and was delivered to the facility at 7:42 PM on 4/16/2021. Patient #5: Review of the medical record indicated Patient #5 was admitted on 5/4/2021. Demographic information indicated the patient lived in a skilled nursing facility. Review of a Coordination Note, dated 5/6/2021, note type "NARRATIVE," indicated that the skilled nursing facility Patient Care Manager requested from the hospice agency RN that some of the patient's medications be discontinued. The hospice agency RN note stated "...this RN is to confer with [NP Name] for orders." Review of a "Hospice Physician Order," dated 5/6/2021, order number "390942," indicated that orders were written for the discontinuation of 5 medications. The order was signed by the NP on 5/7/2021. Tracking information under "Send To Facility" stated "N." Review of a Coordination Note, dated 5/9/2021, note type "NARRATIVE," indicated that the hospice agency LPN met with the skilled nursing facility LPN caring for the patient. The note stated "...LPN requesting to also d/c some of the patient's meds. This nurse checked facility MAR. Med discrepancies noted with routine meds that were d/c'd on 5/6 are still currently active on facility MAR. This nurse contacted clinical MGR [Name] & requested updated MAR be faxed to facility..." During an interview with Employee #1 and Employee #2 on 9/22/2021, beginning at 1:00 PM, the finding was acknowledged and no additional information was provided.