Every finding on record at Ss National Hospice Solutions LLC

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 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 document review, interview and observation. In 2 of 4 (50%) home visit observations where a medication reconciliation was performed comparing the hospice agency medication list to the medications being administered to the patient, it was revealed that the hospice agency did not ensure the drug profile was accurate, and up-to-date. Document 6: Policy #PC.85 titled Medication List and Monitoring (revised 100121) sub-section Policy three (III), stated in part, "Medication monitoring will include appropriate date/information to develop an accurate patient medication history and a current, complete medication profile." Procedure sub-section one (I) stated in part, "The hospice will maintain a current, accurate list of all prescription and over-the-counter (OTC) medications taken by the patient (Medication Profile).." Home Visit 1: The hospice benefit election was dated 11/22/2022. The medication profile included, "Spironolactone Oral Tablet twenty-five (25) mg. Take one (1) tablet orally (PO) two (2) times daily." The caregiver (wife) reported the patient had not taken the medication Spironolactone Oral Tablet twenty-five (25) mg "for months." The medication profile included, "Omeprazole Oral Capsule Delayed release twenty (20) mg. Take one (1) capsule one (1) time daily". The caregiver reported the patient takes Omeprazole Oral Capsule 20 mg One (1) capsule two (2) times daily". The medication profile included, "Mucinex Maximum Strength Oral Tablet Extended Release 12 hour twelve hundred (1200) mg. Take one (1) tablet once a day. The patient's caregiver reported the patient does "not take the Mucinex and hasn't taken it for months." Home Visit 2: The hospice benefit election was dated 4/12/2022. The medication profile dated 4/25/2023 included "Maxide Oral tablet 75-50 mg. Take one (1) tab PO (per oral) QD (every day)". The medication bottle in the home stated, "Triamterene HCTZ (Maxide) 37.5-25 mg. Take one (1) tab PO (per oral) QD (every day)". The medication administration record available in the home provided to the surveyor by the caregiver stated Triamterene HCTZ 37.5-25 mg. Take one (1) tab PO (per oral) QD (every day). The caregiver in the home confirmed the patient is taking Triamterene HCTZ 37.5-25 mg, one (1) tablet daily. A joint record review and an interview were conducted with the Director of Clinical Services on 5/9/2023 and confirmed that the agency medication profiles did not match the medications administered in the homes.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 19 (5%) records reviewed, it was revealed that the hospice did not ensure problems identified on the initial comprehensive assessment were included with interventions written into the care plan. Document 7: Policy # PC.30 titled Plan of Care Process (revised 102022) sub-section Procedure one (I) stated in part, "Information will be gathered from the initial assessment and be used by the hospice to develop the Initial Plan of care (IPOC), physician's orders, and to provide care and services to treat a patient and families immediate care and support needs." Procedure sub-section three (III) (A) stated in part, "The contents of the comprehensive assessment will identify the physical, psychosocial, and emotional needs related to the terminal illness that will be addressed to promote the hospice patient's well-being, comfort, and dignity throughout the dying process." Clinical Record 5: A patient with a hospice benefit election date of 4/16/2023 had an initial RN assessment on 4/16/2023 that identified a present colostomy. The RN assessment documented, "Colostomy stoma pink, normal, and surrounding skin is intact." The RN made scheduled routine visits on 4/17/2023 and 4/20/2023 and documented, "Colostomy stoma pink with liquid brown stool." The RN made an additional PRN visit on 4/20/2023 due to the stoma leaking. The plan of care dated 4/16/2023-7/14/2023 did not provide any documentation or physician orders for directions concerning stoma care. A physician order dated 4/26/2023 stated, "SN to resume to weekly beginning 5/22/2023 to assist with colostomy." On 5/10/2023, the agency provided a supply list of stoma care products being sent to the patient. Joint record review and interview were conducted on 5/10/2023 with the Director of Clinical Services and confirmed that the Plan of Care did not contain any interventions or physician orders concerning the management of the colostomy and stoma.