Failure to Provide Timely Hospice Comfort Medications
Penalty
Summary
A deficiency occurred when the facility failed to provide timely and appropriate care and services to a resident receiving hospice care. The resident, who had a history of hypertensive heart disease with heart failure, chronic diastolic heart failure, and rheumatoid arthritis, was admitted to hospice and required comfort medications for pain, anxiety, and secretions. The hospice physician gave verbal orders for liquid morphine, lorazepam, and hyoscyamine sulfate, which were to be documented and administered by facility staff. However, these orders were not entered into the resident's Medication Administration Record (MAR) or Treatment Administration Record (TAR), and the medications were not provided to the resident as ordered. The delay in medication administration was due to facility staff not entering the hospice physician's orders into the computer system, as well as a request from the DON to have the medications provided in tablet form instead of liquid, citing concerns about drug diversion. The hospice physician and family members reported that the resident had difficulty swallowing, and the liquid form was preferred for faster and easier administration. Despite repeated communication from hospice and family members, the comfort medications were not started promptly, and the resident experienced pain and restlessness during this period. Interviews with facility staff, hospice staff, and family members confirmed that the hospice medication orders were misplaced or not acted upon, and that there was confusion and delay in implementing the hospice plan of care. The resident did not receive the prescribed comfort medications until several days after the initial hospice orders, and only after the orders were rewritten and entered into the system. Observations showed the resident was unresponsive and in distress prior to receiving the medications. The facility failed to coordinate with hospice and follow the resident's plan of care, resulting in unmet needs for pain and symptom management.