Survey Report for 331519

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
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION	331519	A. BUILDING __________ B. WING ______________	04/15/2022
NAME OF PROVIDER OR SUPPLIER	STREET ADDRESS, CITY, STATE, ZIP
VNSNY HOSPICE AND PALLIATIVE CARE	220 E 42ND STREET, 7TH FLOOR, NEW YORK, NY, 10017
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)
L0678
L0678	41671 Based on Clinical record review and staff interview the agency failed to ensure that any new change/ modification in the medications ordered by a physician includes a discontinuation order of the previously ordered medication. This was evident for one of three clinical records reviewed (Patient # 1). Failure to ensure that any new change/ modification in the medications ordered by a physician includes a discontinuation order of the previously ordered medication, has the potential for negative patient outcomes. The Findings are: Patient #1 has a Start of Care date of 12/16/21 with the following diagnoses: " Malignant Neoplasm of Unspecified Part of Unspecified Bronchus or Lung: Chronic Obstructive Pulmonary Disease, Unspecified: Essential (Primary) Hypertension: Hyperlipidemia, Unspecified: Type 2 Diabetes Mellitus without Complications: Age-Related Osteoporosis W/O Current Pathological Fracture: Acute Angle -Closure Glaucoma, Unspecified Eye" documented on the Hospice Certification and Plan of Care for Certification Period 12/16/2021 to 3/15/2022. Date of Death: 01/31/2022. The VNSNY Hospice and Palliative Care Order documents: "Order Date: 1/25/2022 11:2PM - Order Description: Medication: Current Ordered Medications: Type: Start Date: 1/25/2022: Add: Medication -Morphine ER 30 mg tablet, Extended Release -Dose: 1 tablet - Frequency: Every 12 hours- Route: Oral-" The Client Medication Report documents: "Client: Patient#1: Patient Medications: Start Date: 1/25/2022: Morphine ER 30 mg tablet, Extended Release -Dose: 1 tablet - Frequency: Every 12 hours- Route: Oral- Discontinued By : Employee #4 - 01/31/2022." The Client Medication Report documents: "Start Date: 1/29/2022 Morphine Concentrate 100mg/5ml (20mg/ml) Oral Solution hourly Oral PRN." The VNSNY Hospice and Palliative Care Order documents: "Order Date: 1/28/2022 2:01 PM - Order Description: Late entry per note dated 01/28/2022 : Medication: Current Ordered Medications: Type: DC - Discontinue : Medication -Morphine ER 30 mg tablet, Extended Release -Dose: : Start Date: 1/25/2022 - Dose: 1 tablet - Frequency: Every 12 hours- Route: Oral- DC Date 1/28/2022. Approved/ Processed By- RN- Date: 04/15/2022 : Licensed Practitioner Signature - MD- Date: 04/15/2022." The clinical record lacks documented evidence of a physician order to discontinue Morphine ER 30mg tablet, Extended Release, 1 tablet Every 12 hours- Route: Oral prior to 4/15/2022. On 4/15/2022 at 2:30PM the Director of Clinical Services and the Hospice Medical Doctor was interviewed and stated," the verbal order to discontinue the Morphine ER was received on 1/28/2022 , the order was not signed by the Physician."