Failure to Coordinate Hospice Care and Medication Orders
Penalty
Summary
The facility failed to coordinate care and services with a hospice agency for a resident who was receiving hospice care, resulting in discrepancies between the facility's records and the hospice agency's plan of care. The resident, admitted with diagnoses including palliative care and anxiety disorder, had a significant wound on the right breast that was being managed by hospice staff. However, the facility's electronic health record (EHR) did not include an order for wound care, nor did it have a care plan addressing the resident's wound or the use of certain medications prescribed by hospice. There were notable inconsistencies between the facility's medication orders and those from the hospice agency. The facility's EHR listed a different dosage of metronidazole than the hospice agency, included pravastatin which was not on the hospice list, and omitted lorazepam, which was prescribed by hospice for symptom management. Additionally, the facility did not have PDR cream available, despite it being ordered by both the facility and hospice. Interviews with facility staff and hospice personnel confirmed these discrepancies and revealed a lack of medication reconciliation and care plan updates. The facility's policy required coordination with hospice, including reconciling medication orders and care plans, but this was not followed. The Director of Nursing acknowledged that staff should have reconciled medications and care plans with hospice, and the facility did not have a designated hospice coordinator. The process for receiving and communicating new hospice orders was not effectively implemented, resulting in the resident not having appropriate care plans or access to all prescribed medications and therapies.