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 07/14/2022
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)
G0580 Only as ordered by a physician
CFR(s): 484.60(b)(1)

Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner.


This ELEMENT is not met as evidenced by:
Based on medical record (MR) review, policy and procedure, and interview, it was determined the home health agency failed to obtain a physician order prior to administering a medication. This deficient practice affected one of twelve active records reviewed, including Home Visit (HV) # 4, and had the potential to affect all patients served by the agency.




Finding include:




Agency Policy: Physician Orders




Policy Number: 2.1.008




Revision Date: 11/01/21




Purpose:




To outline the process of receiving and documenting physician or authorized practitioner orders.




Policy:




No medications, treatments, diagnostic studies or therapeutics will be administered without the order of a qualified physician or authorized practitioner, ...and that order be reduced to writing and signed/dated by the ordering physician.




Procedure:




...10. Services are provided according to the most recent orders updating the patient's plan of care (POC).




11. In addition to the minimum requirement for medications the following applies:




...b. Resumption of Care (ROC) orders: should contain ALL of the medications the patient is taking status post discharge from the hospital. The blanket reinstatement of previous orders...is not an acceptable practice to the organization.




c. Standing orders: Not applicable in Home health. All orders must be part of the POC.





1. HV # 4 was admitted to the agency on 5/17/22 with diagnoses including Infection/Inflammation Reaction Due To Internal Right Hip Prosthesis and Essential Primary Hypertension.



Review of the ROC orders upon discharge from the hospital dated 6/17/22 revealed an ordered Skilled Nurse (SN) visit frequency of one time a week for five weeks, effective 6/12/22, which included orders for the SN to perform lab draws from a Peripherally Inserted Central Catheter (PICC) vascular access device every Monday beginning 6/20/22.




Further review of the ROC orders revealed the SN was to flush the PICC line with ten milliliters (ml) of Normal Saline (NS) prior to specimen draw, discard ten ml of blood, then flush with ten ml of NS after the specimen draw.




Review of the SN Visit Note Report Narrative dated 7/4/22 revealed the SN documented, "Patient has new PICC Line to right upper arm." "Patient reports that one port is blocked." "SN aspirated several times then was able to slowly flush with heparin."




Review of the ROC medication orders revealed no order for heparin. The SN administered the heparin without a physician's order.




In an interview conducted 7/14/22 at 11:22 AM, Employee Identifier (EI) # 1, Executive Director confirmed there was no order to administer heparin, and the SN should have contacted the physician to obtain a heparin order before administering.