Every finding on record at Nurses Choice Hospice Care Inc

Upon patient record review, 5 of 19 (Patient #1, 2, 3, 5, 12) 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 does not include the instructions for reconstitution of the ordered Miralax which is in powdered form. Additionally, the medication list includes lidocaine transdermal patches for topical use, but does not indicate a location for application. (corrected onsite) Patient 2: The medication list does not include the instructions for reconstitution of the ordered Miralax which is in powdered form. (corrected onsite) Patient 3: The medication list indicates mucus relief 600mg ER 1 tab po bid PRN cough. This is an unacceptable entry as it does not specify the name of the drug and thus cannot be referenced for interactions. Additionally, the medication list includes hydrocortisone cream 1% for topical use, but does not indicate a location for application. (corrected onsite) Patient 5: The medication list includes voltaren gel 1% for topical use, but does not indicate a location for application. (corrected onsite) Patient 12: The medication list includes Refresh 1% eye drops for use, but does not indicate which eye(s) for application. (corrected onsite)

Upon patient record review, 4 of 19 (Patient #1, 3, 5, 12) 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 1: The plan of care includes lidocaine patches for topical use, but does not indicate a location for application. (corrected onsite) Patient 3: The plan of care includes hydrocortisone cream 1% for topical use, but does not indicate a location for application. (corrected onsite) Patient 5: The plan of care includes voltaren gel 1% for topical use, but does not indicate a location for application. (corrected onsite) Patient 12: The plan of care includes Refresh 1% eye drops for use, but does not indicate which eye(s) for application. (corrected onsite)

Upon client record review, 2 of 19 (Patient #4, 8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 4: The plan of care indicates that MSW services and visits were declined at the time of hospice admission, therefore no orders are present for MSW visits. However, the MSW has made monthly visits to the patient's home on 04.14.2024, 05.13.2024, 06.20.2024, 07.04.2024, and 08.04.2024. Patient 8: The plan of care indicates that MSW services and visits were declined at the time of hospice admission, therefore no orders are present for MSW visits. However, the MSW made a visit to the patient's home on 07.21.2024.

Upon patient record review 3 of 19 (Patient #5, 7, 14) 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 5: The plan of care indicates that the HA is to visit the patient 2 x weekly. However, during the week of 07.28.2024, there was evidence that the HA made only 1 visit on 07.31.2024. Patient 7: The plan of care, comprehensive initial nursing assessment, and individual HA care plan all indicate the HA is to visit the patient 2 x weekly. However, since the time of hospice admission, the HA has seen the patient 3 times every week. For example, during the month of July, the patient was seen on the following dates: week 1 - July 1, 3, 5, week 2 - July 8, 10, 12, week 3 - July 15, 17, 19, week 4 - July 22, 24, 25, and week 5 - July 29, 31, August 2. The plan of care was corrected to indicate 3 x weekly. Patient 14: The plan of care indicates that the HA is to visit the patient 3 x weekly. However, during the week of 07.21.2024, there was evidence that the HA made only 2 visits on 07.22.2024 and 07.24.2024.

Upon patient client record review, 5 of 19 (Patient #1, 3, 8, 13, 15) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patients 1, 3, 8, 13, 15: On the day of hospice admission, the patient or representative requested notification of noncovered items, drugs, and services via the signed election statement. However, there was no evidence that the notice of noncovered items addendum was returned to the patient or representative within 5 days or at any subsequent time.