Every finding on record at Sunlight Hospice Company

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, other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, drug therapy associated with laboratory monitoring. 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 and interview. In 1 of 5 (20%) clinical records reviewed, the agency did not ensure that the medication review process included the identification of duplicate drug therapy. Clinical Record 5: The patient elected the hospice benefit on 07/13/2023 with a terminal diagnosis of sepsis. Review of the medication profile revealed Dilaudid 4 mg every 3 hours by mouth as needed for pain with a start date of 07/28/2023 was listed twice in the medication profile. Interdisciplinary team meeting notes dated 07/20/2023 and 07/27/2023 documented a medication review at each meeting. The agency did not identify the duplicative drug therapy ordered for the patient. During interview on 09/15/2023, the Director of Patient Care Services reviewed the associated record and stated the medication had been entered twice in error and had since been corrected.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 5 (20%) clinical records reviewed, the agency did not ensure the patient’s individualized written plan of care included complete treatment orders necessary to meet the needs of the patient. Clinical Record 2: The patient elected the hospice benefit on 07/13/2023 with a terminal diagnosis of congestive heart failure. The physician wound care order/ update to the plan of care dated 08/26/2023 stated in part, “effective 08/28/2023 RLE [right lower extremity] medial tibial vascular stasis ulcer, SN [skilled nurse] to cleanse wound bed with NS 0.9%, cleanse leg with water free foam cleanser, pat dry with a 4x4 gauze, apply ammonia lactate 12% to closed leg skin, using gloved hand apply Medi honey to wound bed. SN to apply Kerlix wrap from foot to 2 finger width below knee bend. SN to apply COBAN wrap over Kerlix.” The order did not include how often the SN should provide wound care to the patient. During interview on 09/15/2023, the Director of Patient Care Services reviewed the associated record and stated the frequency of wound care had inadvertently been omitted from the order and had since been corrected.