Failure to Designate Hospice Care Coordinator and Ensure Timely Medication Management
Penalty
Summary
Facility staff failed to designate a member of the interdisciplinary team to coordinate care with the hospice provider for one resident, as required by the Nursing Facility Services Agreement. The agreement specified that the facility must participate in care coordination meetings, communicate regularly with hospice, and document such communications to ensure the needs of hospice patients are met. During interviews, facility leadership could not identify a specific individual responsible for hospice coordination, and no policy regarding hospice services was available. The resident involved had multiple complex diagnoses, including seizures, COPD, hypertension, heart failure, traumatic brain injury, major depressive disorder, and vascular dementia with psychotic disturbance. The resident was assessed as having moderate cognitive impairment and required maximum assistance with activities of daily living. The resident was receiving hospice services, but the care plan did not incorporate the resident's stated preferences from the MDS assessment, and interventions were limited to medication administration and monitoring. Clinical record review revealed delays in entering hospice-ordered medications onto the Medication Administration Record (MAR), with some medications not added for several days and others never administered despite ongoing behavioral issues. Orders for discontinuing certain medications were not reflected in the MAR, and there was a lack of documentation regarding coordination between facility staff and hospice. These findings demonstrate a failure to meet contractual and regulatory requirements for hospice care coordination.