DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION		 (X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER		 (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
261616 A. BUILDING __________
B. WING ______________ 		12/17/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION MIDWEST 1801 PARK 270 DRIVE - SUITE 150, SAINT LOUIS, MO, 63146
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation
LABORATORY DIRECTOR’S OR PROVIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE

 TITLE

 (X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
(X4) ID
PREFIX
TAG		 SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY SHOULD BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
L0696      
31099 Based on agency policy review, clinical record review and interview the agency failed to ensure the registered nurse (RN) provided education regarding safe medication disposal in, but not limited to, one of two closed records (Record/Patient #4) reviewed. The deficient practice has the potential to affect all patients served by the agency. Findings included: Review of the agency's undated policy titled, "VS Pharmacy Process and Obtaining Orders," showed in part the following: - That the hospice agency must have written policies and procedures for the management and disposal of controlled drugs in the patient's home; - At the time when controlled drugs are first ordered the hospice must provide a copy of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family; and - Discuss the hospice policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family to ensure that these parties are educated regarding the safe use and disposal of controlled drugs. Review of the agency's undated and untitled policy, showed in part the following: - Regulations require that every patient/patient representative receive education regarding the hospice agency Controlled Substance Disposal policies during the admission process; - The What I Need to Know (WINK) about medications outlines the hospice agency's policies regarding disposal of controlled substances and is shared with the patient/patient representative during the admission process; - Review the WINK about medication with the patient and family at the time of admission and reinforce as needed. It might be especially helpful to review at the time of death; - Any controlled substance ordered as part of the hospice plan of care that s discontinued or no longer needed due to the patient's death should be destroyed; - Controlled substances that require destruction must be destroyed either by the patient or the patient representative; and - Hospice agency staff will be available to provide guidance and instruction on proper disposal methods. Review of the agency's undated, "WINK" handout, showed in part the following: - When controlled drugs are no longer needed by the patient, they should be disposed of by the patient/caregiver; - It is recommended that all medications that are no longer needed should be disposed of; and - The hospice agency staff are available for any questions about drug disposal, but will not dispose of patient medication. RECORD/PATIENT #4: Review of the patient's nursing-updated comprehensive assessments showed the patient received the following controlled medications: - Alprazolam (Xanax) 0.25 milligrams (mg) and 0.5 mg (anti-anxiety); - Hydromorphone (Dilaudid) 4 mg (opioid to treat moderate to severe pain); - Marinol (Dronabinol) (cannabinoids used for nausea, vomiting and appetite); - Morphine (MS Contin) 30 mg tablets (opioid for severe pain); - Morphine (Roxanol) (narcotic medication for moderate to severe pain) concentrate; and - Hydrocodone/acetaminophen (Norco) 5/325 mg (narcotic pain medication). Review of the Transfer/Discharge Summary/Instructions report dated 9/11/2020 showed the following: -The patient expired at home; and -The section for Disposal of Controlled and/or Prescription Medication Form had boxes for Completed, N/A and a Comment section and all three areas were blank. The RN did not indicate if he/she provided education regarding safe medication disposal. During an interview on 12/16/2020 at 10:18 AM the patient's care giver/family member said when the patient passed he/she had all this controlled substance (narcotics) in his/her house and the hospice agency hadn't told him/her what to do with it after the patient's death. He/She had been asked on admission how she stored the medications but was never educated on what to do with the narcotics after death. An adult child called the hospice agency and asked what to do with the narcotics. The agency responded, it wasn't their problem and to call the local police department. There was no offer for the hospice agency to go out to the patient's home and assist with medication destruction. During an interview on 12/16/2020 at 4:34 PM the National Patient Care Administrator said there was no written instructions about medications with the patient's discharge and he/she expected the nurse to go out to the patient's home and help them destroy the narcotics if the family/caregiver asked for help.