Every finding on record at Qa Care Hospice

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies and other alternative treatments that could affect drug therapy. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by clinical record review, document review, interview, and observation. 1 of 5 (20%) clinical records reviewed revealed the hospice did not ensure a drug regimen review was completed for all current medications the patient was taking at the time of the comprehensive assessment. Record #34186: a comprehensive assessment was completed on 12/29/2021. During the home visit on 1/26/2022, the patient and family reported Ibuprofen was effective for pain relief. A prescription bottle for Ibuprofen dated 12/13/2021 revealed the patient had this prescription prior to the hospice admission. This medication was not listed on the patient's medication profile and was not reviewed at the time of the comprehensive assessment. Hospice Policy "MEDICATION PROFILE" Policy No. 3-002.1, revised September 2021 stated, “For accuracy and to completely reconcile medications across the continuum of care, the admitting organization will obtain and document a complete list of the patient’s current medications upon the patient’s entry to the organization. A comparison of the medications ordered for the patient while under the organization’s care will be made to those on the list. The admitting nurse will initiate a medication profile to document the current medication regimen, including name, dose, strength, route, frequency, date and time of administration and a diagnosis, condition, or indication for use for each medication ordered. A drug regimen review will be performed at the time of initial and comprehensive assessment. The review will assist in evaluating effectiveness and appropriateness, identify potential and actual drug/food interactions, adverse reactions, duplicative therapy and noncompliance issues, omissions and unclear information”. This finding was confirmed by the administrator on 1/27/2022.

It is required that the update of the comprehensive assessment is completed by the hospice Interdisciplinary Group, who, in collaboration with the individual’s attending physician, if any, consider the changes that have taken place since the initial assessment. The update of the comprehensive assessment includes information on the patient’s progress toward desired outcomes; reassessment of the patient’s response to care. The assessment update is completed as frequently as the condition of the patient requires; no less frequently than every 15 days. This standard was not met as evidenced by clinical record review, document review, and interview. 3 of 5 (60%) clinical records reviewed revealed the hospice did not ensure that the updated comprehensive was completed by the interdisciplinary group registered nurse (RN) at least every 21 days, as permitted under the the 2020 Hospice Federal Blanket Waiver. Record #31610 was reviewed and identified an initial comprehensive assessment was completed by a Registered Nurse on 12/28/2021. Licensed Vocational Nurse visits were completed on 1/6/2022, 1/14/2022 and 1/19/2022. There was no documented evidence of a comprehensive assessment completed by a Registered Nurse between 12/29/2021 and 1/25/2022, which was 28 days. Record #17099 was reviewed and identified an initial comprehensive assessment was completed by a Registered Nurse on 12/27/2021. Licensed Vocational Nurse visits were completed on 1/7/2022, 1/15/2022 and 1/19/2022. There was no documented evidence of a comprehensive assessment completed by a Registered Nurse between 12/28/2021 and 1/25/2022, which was 29 days. Record #34186 was reviewed and identified an initial comprehensive assessment was completed by a Registered Nurse on 12/29/2021. Licensed Vocational Nurse visits were completed on 1/4/2022, 1/10/2022 and 1/20/2022. There was no documented evidence of a comprehensive assessment completed by a Registered Nurse between 12/30/2021 and 1/25/2022, which was 27 days. Hospice Policy "HOSPICE NURSING CARE" Policy No. 2-005.1, revised September 2021 stated, “The hospice registered nurse performs initial, comprehensive and ongoing comprehensive assessments regarding the impact of the terminal diagnosis on the patient’s physical, functional, psychosocial, and environmental needs and activities of daily living”. Registered Nurse #62256 was interviewed on 1/26/2022 and stated, comprehensive assessment visits are completed by the Registered Nurse every two weeks. The Administrator confirmed this finding on 1/27/2022.