Volume 2025 | No. 2
SURVEYOR
HOSPICE
Compliance tips for:
Examples of ACHC Surveyor findings: ■ During the Surveyor-attended home visit, the patient was interviewed regarding medications. The patient identified four current medications. These medications were not included on the most recent plan of care. ■ Nursing documentation identifies that the patient receives tube feedings for nutritional needs. There was no evidence of an order for formula type, rate, or amount and frequency. ■ The medical record contained an order for oxygen equipment and supplies, and the plan of care contained problems, goals, and interventions related to oxygen safety. There was no evidence of an order for the oxygen rate, frequency, or delivery method. ■ Patient has an indwelling foley catheter. Catheter supplies are not included on the plan of care. ■ Plan of care orders: baclofen 20mg by mouth daily for mild pain 0-3. Hydrocodone/Tylenol 10mg/325mg by mouth every 4 hours as needed for severe pain 7-10. There is no evidence of intervention for pain 3-7 on the plan of care.
The intent of the standard is to anticipate effects that may endanger the patient’s life or wellbeing through ongoing review of medications for potential interactions, duplicate drug therapy, allergic reactions, and changes in condition that contradict continued administration. ■ Audit medication profiles to verify required elements are present, including: ٝ All current medications including over the counter, herbal remedies, and other alternative treatments. ٝ Date prescribed or taken. ٝ Medication name. ٝ Dose, route, frequency. ٝ Date discontinued (if applicable). ■ Compare profiles to plan of care and visit notes to ensure that updated orders are reflected in the current profile. ■ Interview the patient and caregiver for compliance with dosage and schedule for self-administered medications. ■ Educate the patient/family on symptoms of concern. ■ Train staff to check medications onsite during home visits in addition to comparing documentation. Review for potential effects or interactions. ■ Include profile reviews in IDG meetings.
Nerd Newbies (understand the requirement)
Nerd Apprentices (audit for excellence)
Compliance tips for:
This standard is the most frequent deficiency cited on hospice surveys. Surveyors are looking for a level of detail in the plan of care that effectively supports continuity of palliative care. Visit frequency orders must be specific enough to allow the IDG to plan proactively for the patient’s changing needs. ■ Audit plans of care to ensure each order is specific as to procedure, frequency, modality, dosage, parameters, etc. ٝ Correct inconsistencies immediately. ■ D ME used in the course of care must be listed on the plan of care (beds, wheelchairs, oxygen concentrators, catheter supplies, etc.) ■ Train for excellence in communication among IDG members, caregivers, family, and the patient. Relationship-building is an essential aspect of hospice care which extends beyond the death of the patient.
Nerd Trailblazers (prepare the path for others)
Nerd Newbies (understand the requirement)
Nerd Apprentices (audit for excellence)
HSP5-4A Frequency of the citation: 71%
Nerd Trailblazers (prepare the path for others)
Overview of the requirement: Each patient has an individualized written plan of care developed by the hospice interdisciplinary group based on the initial, comprehensive, and updated comprehensive assessment information, in consultation with the physician and the patient and/or their primary caregiver. The plan includes all services necessary to palliate and manage terminal illness and reflects family preferences. Comment on deficiencies: Compliance is evaluated through review of patient records, policies, and procedures. The plan of care should be a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. Most deficiencies resulted from orders that did not specify amount, frequency, or duration. Specifically, medication orders were often lacking dose, frequency, and/or route. During home visits, surveyors frequently identified DME in use by the patient but not reflected in the plan of care.
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