Volume 2024 | No. 2
SURVEYOR
HOSPICE
n The comprehensive assessment did not contain a complete assessment of spiritual needs related to terminal illness. n Patient records do not contain all spiritual components of loneliness, despair, fear, forgiveness, reconciliation, inner strengths, weaknesses. n Imminence of death is not documented in the comprehensive assessment as the admitting nurse did not complete this area on admission form. n Comprehensive assessment did not include economic components, funeral preferences, and nature and scope of spiritual concerns. n Monitor timeframes and complete all components of the comprehensive assessment within five calendar days of the election of hospice care. n Ensure the inclusion of a bereavement risk assessment identifying the needs of the patient’s family and other individuals and focuses on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. n When evaluating the spiritual component, gather information that covers the entire scope of potential concerns: loneliness, despair, fear, guilt, anger, forgiveness, reconciliation, and inner strengths and weaknesses. A registered nurse creates and maintains a medication profile. The RN reviews all patient medications during the interdisciplinary group (IDG) meeting and whenever needed. Evidence of compliance is assessed through response to interviews, observation of home visits, and review of patient records, policies, and procedures. Most deficiencies resulted from lack of route, dosage, and/or frequency. Surveyors also found that many medications were prescribed in orders that were not reflected on the medication profile.
n Oxygen machine and nebulizer were listed in DME section of plan of care. No nebulizer or oxygen meds were ordered or on medication list. n During home visit, two medications were confirmed by the nurse and caregiver as active and still being taken daily by the patient but were discontinued in the patient record medication profile. n The medication profile contains an order for Miralax with no diluent. n The medication profile includes two medications ordered for pain without parameters/differentiation for administration. n The medication profile was not updated. Insulin subcutaneous injection was active on survey day, but upon verification with board and care administrator, this patient was no longer on insulin as ordered by the physician. There was no coordination documenting clarification with physician. n Regularly review medication profiles and update to reflect changes in orders. n Ongoing review includes anticipating effects or interactions that may endanger the patient’s life or wellbeing. The nurse and IDG should instruct the patient/family as necessary and implement preventive measures. Audit medication profiles and verify required elements are present. All current medications. Date prescribed or taken. Medication name. Dose, route, frequency. Date discontinued (if applicable). Each patient has an individualized written plan of care developed by the hospice interdisciplinary group, in consultation with the physician and based on comprehensive assessment information. The plan includes all services necessary to palliate and manage terminal illness and related conditions, including medications and treatments. 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.
Tips for compliance:
Tips for compliance:
HSP5-3D Overview of the requirement:
Comment on deficiencies:
HSP5-4A Overview of the requirement:
Frequency of citation:
61%
Examples of surveyor findings:
n There is no evidence of clear instruction on when to administer dose. n Medication instructions state, “take per instructions on package” with no evidence of education or instruction on proper dosing. n The record indicates a nursing order was received to increase the patient’s dosage. The medication profile was not updated. n The nurse documents the patient has oxygen orders, but oxygen is not listed on the medication profile. n The medication profile contained medication “as needed” with no evidence of instructions for frequency or maximum doses. n The medication profile contained oxygen with no evidence of route.
Comment on deficiencies:
Frequency of citation:
81%
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