Every finding on record at Tri-County Hospice Services, Inc.

Upon patient record review, 4 of 19 (Patient #4.#8,#10,#13) 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 4: The medical record incudes an entry on 12/1/23 for Nystatin cream to affected area x 10 days. The medication remains profiled as a current medication on 2/21/24. COS Patient 8:The medical record includes an entry on the medication profile upon admission of Metamucil 2 tablespoons po daily PRN. There is no evidence that the profile includes a type and amount of diluent for administration. COS Patient 10 and 13:The medical record includes an entry on the medication profile upon admission of MiraLAX 17 grams po daily PRN. There is no evidence that the profile includes a type and amount of diluent for administration. COS

Upon patient record review, 1 of 19 (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. Patient 3: The medical record contains documentation of oxygen use at 2 liters per minute via nasal cannula as needed. There is no evidence on the plan of care to include problems, goals and interventions related to oxygen management and safety. COS

Upon patient record review, 3 of 19 (Patient #8,#10,#13) 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 8:The medical record includes an order on admission for Metamucil 2 tablespoons po daily PRN. There is no evidence that the order includes a type and amount of diluent for administration. COS Patient 10 and 13:The medical record includes an order on admission for MiraLAX 17 grams po daily PRN. There is no evidence that the order includes a type and amount of diluent for administration. COS

Upon patient record review, 2 of 19 (Patient #4,#6) 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 4: The medical record contains nursing documentation of symptoms of a yeast infection under right breast with an order obtained from the physician to treat with Nystatin topically and po Diflucan. There is no evidence of an update to the plan of care to include problems goals and interventions for an active infection. COS Patient 6:The medical record contains nursing documentation of symptoms of a wound infection with an order obtained from the physician to treat with Bactrim po BID x 10 days. There is no evidence of an update to the plan of care to include problems goals and interventions for an active infection.