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 017027 (X3) Date Survey Completed 09/26/2018
Name of Provider or Supplier Hga Homecare, Llc Street Address, City, State 2050 Beltline Rd Sw, Decatur, 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)
G0536 A review of all current medications
CFR(s): 484.55(c)(5)

A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy.


This ELEMENT is not met as evidenced by:
Based on review of agency policy, medical records (MR), observations and interviews, it was determined the agency failed to ensure the Client Medication Report (CMR) was current and accurate for all patient medications. This affected 2 of 7 home visit (HV) records reviewed, including HV # 1 and # 4 and had the potential to negatively affect all patients admitted to this agency.



Findings include:



Policy: Monitoring Medications

Policy Number: 10.008

Revised Date: 02/01/2018



Purpose: To provide a process to ensure continuous monitoring of medications in the patient's home.



Policy: A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode.



...The therapist will participate by monitoring and reporting any identified medication issues or non-compliance to the Patient Care Manager.



...The physician is contacted immediately if any discrepancies between agency information and patient medications are found.



Procedure:

...a. Compare medication list obtained from the facility from which the patient was transferred and/or physician orders to actual medications patient is taking.

b. Review all medications including over the counter medications...to identify issues such as:

i. Potential adverse effects and drug reactions

iii. Significant side effects;

v. Contraindicated medications...



****



1. HV # 1 was admitted to the agency 8/18/18 with diagnoses including Dizziness and Giddiness, Other Pancytopenia, Atherosclerotic Heart Disease, Old Myocardial Infarction, Personal History of Nicotine Dependency and History of Falling.



A home visit was completed on 9/24/18 at 11:30 AM with Employee Identifier (EI) # 4, COTA (Certified Occupational Therapy Assistant). EI # 1, Executive Director (ED) was present during the visit.



The CMR provided to the surveyor prior to the visit was compared with the medication found in the home and reviewed with the patient during the home visit.



B12 1000 micrograms 1 tablet by mouth daily was found in the home and reported by the patient in use for the last 10 days. The B12 was not documented on the current CMR.



Eye Allergy Relief drops were documented on the CMR and not found in the home.



During an interview on 9/26/18 at 9:35 AM, EI # 3, Performance Improvement Coordinator confirmed the aforementioned findings.



2. HV # 4 was admitted to the agency on 8/26/18 with diagnoses including Cellulitis of Right Lower Limb, Type II Diabetes Mellitus with Diabetic Chronic Kidney Disease.



A HV was conducted on 9/24/18 at 2:27 PM with EI # 5, Registered Nurse to observe PICC (Peripherally Inserted Central Catheter) care and laboratory draw from the PICC.



During the HV, the patient's medications were reviewed with the patient using the CMR provided to the surveyor by the agency and medication bottles In the home.



The following medications were on the CMR with an incorrect dosage or administration frequency:



Fluconazole 100 mg (milligram) 1 spray daily was documented on the CMR.

Fluconazole 200 mg 1 spray daily was documented on the medication bottle and confirmed by the patient. The date the medication was changed was 8/26/18.



Clonidine HCL (Hydrochloride) 0.1 mg 1 tablet 3 times a day was on the CMR.

Clonidine HCL 0.1 mg take 1 tablet PRN (as needed) 3 times a day for a SBP (Systolic Blood Pressure) medication bottle dated 9/13/18.



Niacin 1000 mg take 1 tablet daily was on the CMR. Niacin 500 mg 2 tablets daily was documented on the medication bottle.



Novolog Flexpen U (unit) - 100 Insulin Aspart Subcutaneous 5 units 3 times a day was on CMR.

Novolog Flexpen U- 100 Insulin Aspart Subcutaneous 18 Units to start, then according to the sliding scale 3 times a day was on the medication package. The patient confirmed the Novolog dosage was changed about 4 weeks ago.



The following medication was found in the home and not documented on the CMR:



Vibativ 1000 mg in 250 ml (milliters) of Normal Saline IV (Intravenously). The start date was 1 1/2 weeks ago according to patient and caregiver.



On 9/24/18 at 3:20 PM, the surveyor interviewed the patient and caregiver regarding the medications and asked if the nurses check the patient's medications every week? The patient stated "No, that is why I wanted to know why you are checking them. No one ever asks for the pill bottles."



An interview was conducted on 9/24/18 at 3:30 PM with EI # 1, ED who confirmed the above mentioned findings.