Every finding on record at Panacea Hospice, Inc

Upon patient record review, 7 of 14 records reviewed (Patient #1, #2, #3, #6, #7, #8, #10) 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 #1: The medication profile indicated Povidone iodine 10% 1 application topically to affected area once a day @ bedtime. There was no evidence as to where the Povidone iodine should be applied. Patient #2: The medication profile indicated Oxygen inhalation @ 2-5 liters/minute via NC or face mask for SOB. There was no indication for when to increase the oxygen level. In addition: The record indicated Nutren 1.5 Bolus/PEG 4 times daily. There was no amount listed to bolus. Patient #3: The medication profile indicated Regular Insulin 100U/ml 1 vial 1 dose SQ per sliding scale before meals. There was no evidence of a defined sliding scale to show the parameters of insulin to give based on the blood sugar reading. Patient #6: The medication profile indicated Olopatadine Hydrochloride 0.1% 1-2 gtts opthalmic daily as needed for dry eyes/itch. There was no evidence of which eye or eye(s) to put the drop in. Patient #7: The medication profile indicated two different medications on the MAR for Acetaminophen (Acetaminophen 500mg Q6hours prn NTE 3grams) the second medications on the MAR was Acetaminophen 500mg 2 caps BID). There was no evidence on the second Acetaminophen medication not to exceed 3 grams. The two medications listed combined would be 4 grams if max amount ordered was given. In addition: Arnicare Pain Relief 1 application apply to affected area daily was listed, there was no site listed as to the specific area affected. Also Bacitracin was listed to apply to the affected area, no evidence of the specific area. Patient #8: Ketotifen Fumarate Ophthalmic solution 0.035% one drop twice a day. No specific eye or eye(s) listed. Patient # 10: The medication profile indicated Novolog 100 Unit/ml SQ TID before meals per sliding scale. There was no evidence of a sliding scale. In addition: Hydrocortisone 1% topical cream twice daily on affected areas. There was no evidence of the specific affected area.

Upon patient record review, 1 of 14 records reviewed (Patient #5) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #5: The record indicated MD labs ordered for a CA-19, CEA, CBC with diff, CMP, Thyroid Panel, Lipid Panel, and a BNP was ordered on 5/2/24. The record had no evidence of the RN ensuring continuous assessment as the results for these labs were not on the chart as of 5/15/24 and no evidence the results were called to the ordering physician.

Upon patient record review, 1 of 14 records reviewed (Patient #5) 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 #5: The record indicated the patient was on Eliquis 2.5mg po BID. There was no evidence the plan of care included bleeding precautions.

Upon patient record review, 7 of 14 records reviewed (Patient #1, #2, #3, #6, #7, #8, #10) 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 MD order was written for Povidone iodine 10% 1 application topically to affected area once a day @ bedtime. There was no evidence in the MD order as to where the Povidone iodine should be applied. Patient #2: The MD order was written for Oxygen inhalation @ 2-5 liters/minute via NC or face mask for SOB. There was no indication for when to increase the oxygen level. In addition: The record indicated Nutren 1.5 Bolus/PEG 4 times daily. There was no amount listed to bolus. Patient #3: The MD Order was written for Regular Insulin 100U/ml 1 vial 1 dose SQ per sliding scale before meals. There was no evidence of a defined sliding scale to show the parameters of insulin to give based on the blood sugar reading. Patient #6: The MD order was written for Olopatadine Hydrochloride 0.1% 1-2 gtts ophthalmic daily as needed for dry eyes/itch. There was no evidence of which eye or eye(s) to put the drops in. Patient #7: The MD order was written for two different dosing's for Acetaminophen (Acetaminophen 500mg Q6hours prn NTE 3grams) the second order was (Acetaminophen 500mg 2 caps BID). There was no evidence on the second Acetaminophen order not to exceed 3 grams. The two medications listed combined would be 4 grams if max amount ordered was given. In addition: Arnica Pain Relief 1 application apply to affected area daily was listed, there was no site listed as to the specific area affected. Also Bacitracin was listed to apply to the affected area, no evidence of the specific area. Patient #8: Ketotifen Fumarate Ophthalmic solution 0.035% one drop twice a day. No specific eye or eye(s) listed. Patient # 10: The MD order was written for Novolog 100 Unit/ml SQ TID before meals per sliding scale. There was no evidence of a sliding scale. In addition: Hydrocortisone 1% topical cream twice daily on affected areas. There was no evidence of the specific affected area.

Upon client record review, 1 of 14 (Patient #2) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #2: The record indicated IDG was due on 4/22/24 and 5/6/24. There was no evidence of the IDG meetings. Corrected on site.

Upon patient record review, 5 of 14 records reviewed (Patient #3, #5, #6, #10, #12) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #3: The hospice legal document stated it is "Panacea Policy" that requires a mortuary arrangement is required as part of the admission process. There was no evidence of progress towards the care plan in completing the required mortuary information. Patient #5: The hospice legal document stated it is "Panacea Policy" that requires a mortuary arrangement is required as part of the admission process. There was no evidence of progress towards the care plan in completing the required mortuary information. Patient #6: The hospice legal document stated it is "Panacea Policy" that requires a mortuary arrangement is required as part of the admission process. There was no evidence of progress towards the care plan in completing the required mortuary information. Patient #10: The record indicated continuous care was ordered and provided from 08/14/23 to 08/15/23. There was no evidence of a plan of care to include interventions to manage the pain and symptoms and here was no evidence in the chart of an individualized plan of care to reflect the interventions and or patient/family goals for the unmanaged symptoms. Patient #12: The hospice legal document stated it is "Panacea Policy" that requires a mortuary arrangement is required as part of the admission process. There was no evidence of progress towards the care plan in completing the required mortuary information.

Upon client record review, 1 of 14 records reviewed (Patient #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: The record indicated by MD orders the Spiritual Care visits were ordered 1 X M, the start of care was 12/22/23. There was no evidence of monthly visits since the last spiritual visit on 12/26/23 as of 05/15/24.