Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 017009 (X3) Date Survey Completed 04/26/2018
Name of Provider or Supplier Eh Health Home Health Of Birmingham, Llc Street Address, City, State 1 Chase Corporate Drive, Suite 210 A, Hoover, AL
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
G0590 Promptly alert relevant physician of changes
CFR(s): 484.60(c)(1)

The HHA must promptly alert the relevant physician(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered.


This ELEMENT is not met as evidenced by:
Based on review of the agency's policies and procedures, medical record review (MR) and interview, it was determined the agency failed to:



1. Notify the physician when a patients wound deteriorated in 4 of 5 records reviewed with wounds that deteriorated including MR # 1, # 2, # 4 and # 5.



2. Notify the physician the patient had not received the ordered feedings 1 of 1 record reviewed with tube feeding including MR # 4.



3. Inform the physician of problems related to the patient's Peripherally Inserted Central Catheter (PICC) care on 1 of 1 patient record reviewed including MR # 2.



This deficient practice had the potential to negatively affect all patient served by this home health agency.



Findings include:



Policy: Monitoring Patient's Response/ Reporting to Physician

Policy No: HH 2-015

Revised: 11/2017



Policy



Clinicians will establish and maintain ongoing communication with the physician to ensure safe and appropriate care for the patient.



Procedure



3. Licensed Clinicians will contact the Physician (MD) from bedside and note call on the vital sign communication tool when any of the following occur regarding, but not limited to the following:

A. Significant changes in the patient's condition.



E. Changes that have occurred regarding diagnosis, prognosis, or treatment (including procedures, medications, precautions and limitations.



4. All conference attempts to communicate with physician will be documented in the clinical record.



5. When unable to contact the patient's physician for medical consultation warranted by the change in the patient;s condition, the following procedures will be followed:

A. The nurse or therapist will immediately notify the Clinical Supervisor or designee regarding the need for medical consultation and problems encountered.

B. It remains the responsibility of the clinician originating MD contact to ensure appropriate follow-up was made.

C. Best clinical judgement should be utilized to ensure patient care needs are met timely.



1. MR # 1 was admitted to home health on 9/9/17 with the diagnoses of Stage IV Pressure Ulcer Sacral Region and Micro Findings of Specimen from the Respiratory System



Review of the Skilled Nurse (SN) SOC visit note 4/25/18 revealed on documentation of 1 area of undermining on # 1, Mid Sacral PU, Stage IV of 3 cm (centimeters) at 10 o'clock.



Further review of the MR revealed the presence of 2 undermining areas note on visit 9/18/17;

# 1- Stage IV PU Mid Sacral region with 1 cm (centimeter) at 7-8 o'clock and 0.5 cm at 4-6 o'clock. There was no documentation the physician was notified.



An interview was conducted on 4/26/18 at 9:00 AM with EI (Employee Identifier) # 1, Branch Manager (BM) who confirmed the above mentioned findings.



2. MR # 2 was admitted to home health on 9/30/17 with the diagnoses including Sepsis, Unspecified Organism, Pressure Ulcer on Left Heel, Stage II, Pressure Ulcer on Right Heel, Stage II and Pressure Ulcer on Other Site, Stage 2.



Review of the SN visit note 11/28/17 on 4/23/18 revealed documentation the wound on the Right Heel increased in size from 11/20/17 at 1.3 cm.(centimeter) L (length) c 2.5 cm W (width) x 0.1 cm D (depth) to 3.5 cm L x 4 cm W x 0 cm D. There was no documentation the physician was notified of the increased size of the Right Heel wound.



An interview was conducted on 4/26/18 at 9:30 AM with EI # 1 who confirmed the above mentioned findings.



3. MR # 4 was admitted to home health on 12/4/17 with the diagnoses including Pressure Ulcer of Right Buttock, Stage III and Hypertensive Chronic Kidney Disease, Stage I - IV.



Review of the HHC and POC dated 12/4/17 to 2/1/18 revealed the following wound orders: SN to apply Negative Pressure Wound Therapy (NPWT) to Right Upper Buttock and a frequency of 3 times a week. Cleanse/ Irrigate (R) Buttock with dermal wound cleanser/ saline, apply skin protective barrier to peri-wound skin. Cut the black Granufoam to fit the size and shape of the wound, place the foam into the wound cavity, picture frame the wound edges with transparent dressing, cover the sponge with transparent dressing. choose location on the dressing to apply trac pad, cut a hole thru the transparent dressing exposing the foam, apply the trac pad to the cut home and seal onto the dressing, connect trac pad tube to the canister and set the therapy setting to 125 millimeter of mercury (mm/Hg).



Review of the SN visit note 12/12/17 on 4/25/18 revealed documentation of the presence of tunneling on the coccyx measuring 2.5 cm. There was no documentation the physician was notified.



Review of the HHC & POC dated 12/4/17 to 2/1/18 the following PEG (Percutaneous Endoscopic Gastrostomy) feedings: administer 240 cc (cubic centimeters) of Jevity 1.5 bolus TID (three times a day) per PEG. Flush with 60 cc of water prior to and following feedings. ..



Review of the SN visit notes 12/13/17, 12/15/17, 12/18/17 and 12/20/ 17 on 4/25/18 revealed documentation the patient "has not received tube feedings". On 12/13/17 SN documented the agency clinical manager was notified. There was no documentation the physician was notified.



In an interview conducted on 4/26/18 at 9:00 AM with EI # 1 who confirmed the staff failed to follow agency's policy and procedures.



4. MR # 5 was admitted to home health on 11/17/17 with the diagnoses including Pressure Ulcer Left Hip, Stage III and Pressure Ulcer of Sacral Region, Stage II.



Review of the HHC and POC's Goals/ Rehabilitation Potential/ Discharge Plan dated 11/17/17 to 1/15/18 revealed documentation the patient's pressure ulcers will heal within 9 weeks.



Review of the SN visit note 12/5/17 on 4/25/18 revealed an increased in width measurement of the patient Left Iliac Crest , Stage III PU had increased from 2.8 cm (centimeter on 11/27/17 to 7.8 cm on 12/5/17. There was no documentation the physician was notified.



In an interview conducted on 4/26/18 at 9:15 AM with EI # 1 who confirmed the above mentioned findings.