Every finding on record at Three Rivers Hospice Inc

Upon patient record review, 5 of 14 (Patient #4, #5, #7, #9, #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 #4-Medication profile indicated order for Aspercreme 4% topical ointment, apply to affected area 2xday for muscle pain. Amount and location for application not specified.-Corrected on-site. #5-During home visit it was noted that patient medication profile currently lists the following medications that patient is no longer taking. This was also confirmed by nurse at visit: Cymbalta one 30mg and one 20mg capsule to be taken together po daily for nerve pain, Lidocaine patch 4% topical one patch to skin of the affected area for pain, 12 hours on and 12 hours off, ipratropium 0.5mg-albuterol 3mg nebulizer solution, one vial q4hours prn for SOB, albuterol sulfate 90mcg/actuation breath activated powder inhaler, two puffs inhaled as needed for SOB, fentanyl 100mcg/hr transdermal patch, apply one patch to skin and change q72 hours-All corrected on-site. #7-Medication profile indicated order for Miralax 17g/ dose oral powder daily. Mixing instructions not included.-Corrected on-site. #9-During facility visit it was noted that patient is no longer taking lisinopril, but lisinopril order remains on hospice medication profile with an order dated 10/12/23, there is one duplicate order for fentanyl125mcg/hour transdermal patch dated 08/07/24, there are two orders for lorazepam on the hospice medication profile (orders dated 08/23/24 and 10/03/24) these two orders do not match the lorazepam order on the facility profile.-All corrected on-site. #10-Medication profile indicated order for Aspercreme 4% topical ointment, apply to affected area 4xday for muscle pain. Amount and location for application not specified.-Corrected on-site. Medication profile indicated Neosporin apply to affected area daily prn to prevent infection. Amount and location for application not specified.-Corrected on-site.

Upon patient record review, 1 of 14 (Patient #3) 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. #3-Care plan identified pain as a problem and included a goal without intervention other than "coordination with facility staff."-Corrected on-site.

Upon patient record review, 9 of 14 (Patient #1,2,3,5,6,7,8,9,10) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. #1,2,3,5,6,8,9,10-Patients had following prn visit frequency orders : RN 10prn, SW 5prn, SC 5prn, which is excessive for the benefit period.-Corrected on-site. #7-Patient had 5prn SW and 5prn CH visit frequency orders, which is excessive for the benefit period.-Corrected on-site.

Upon patient record review, 3 of 14 (Patient #4,7,10) 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. #4-Plan of care indicated order for Aspercreme 4% topical ointment, apply to affected area 2xday for muscle pain. Amount and location for application not specified.-Corrected on-site. #7-Plan of care indicated order for Miralax 17g/ dose oral powder daily. Mixing instructions not included.-Corrected on-site. #10-Plan of care indicated order for Aspercreme 4% topical ointment, apply to affected area 4xday for muscle pain. Amount and location for application not specified.-Corrected on-site. Plan of care indicated Neosporin apply to affected area daily prn to prevent infection. Amount and location for application not specified.-Corrected on-site.

Upon client record review, 1 of 11 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: Pt admitted to services 9/24/21. Visit orders for SC and MSW were for 2 times a month. SW visits in Nov were 11/8; 11/18 and 11/29. Chaplain visits in Nov. were 11/15; 11/18/ and 11/29. There was not evidence of orders for the additional visit. Corrected onsite.

Upon contract review, 1 of 2 applicable (DB) did not have evidence that the contract was clear that it was for the role of the alternate medical director. This was corrected on site.