| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017035 | (X3) Date Survey Completed 03/17/2022 |
| Name of Provider or Supplier Infirmary Home Health Agency, Inc. | Street Address, City, State 851 E I-65 Service Rd S, Suite 1000, Mobile, 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 and procedure, medical record (MR) reviews and interviews, it was determined the agency failed to ensure the medications were current for 4 of 17 MR's reviewed, including Home Visit (HV) # 1, MR # 9, HV # 3 and HV # 7 and had the potential to affect all patients served by the agency. Findings include: Agency Policy: Monitoring Medications Policy Number: 10.008 Revised Date: 5/1/19 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. Procedure: 2. All clinicians participating in the patient's care are responsible to assist with the maintenance of accurate patient medication information throughout the episode of care. During the patient's episode of care the following will occur: a. Through a collaborative process the care team will: Compare medications patient is currently taking with medications ordered for the patient in order to identify and resolve discrepancies... b. The Physician will be notified of discrepancies and documentation of notification must be evident in the medial record. 4. HV # 7 was admitted to the agency on 2/7/22 with admitting diagnoses of Abscess of The Breast and Nipple and Necrotizing Fasciitis. A HV was conducted on 3/16/22 at 12:00 PM and the medications were reviewed with the patient during this visit using the medication bottles and the Medication List provided to the surveyor by the facility. During the review of the medications the following medication was on the list and the patient stated was no longer taking the medication: Amlodipine 10 mg 1 tablet daily. Discontinued about 3 weeks ago according the patient. A skilled nurse made a visit on 3/9/22 and the medication had been discontinued prior to the 3/9/22 visit and was not removed from the Medication List. The following medication was on the Medication List and not in the home: Zinc Sulfate 50 mg 1 capsule daily. The patient stated she should be taking it and ran out and has not gotten any more. An interview was conducted on 3/17/22 at 9:35 AM with EI # 6, who confirmed the medications should be reviewed on every visit and corrections should be made at that time. 2. MR # 9 was admitted to the agency on 1/15/22 with diagnoses including Epilepsy and Quadriplegia. Review of the SN visit note dated 2/23/22 revealed the nurse documented "...with Tracheostomy patent and conncted (connnected) to humidified O2 (oxygen)..." Review of the Home Health Certification and Plan of Care dated 1/15/22, Medications, revealed no order for Oxygen therapy. In an interview conducted on 3/16/22 at 4:30 PM, EI # 6, Process Improvement Coordinator, confirmed Oxygen was not listed on the medication list provided and there was no order documented for Oxygen therapy. 3. HV # 3 was admitted to the agency on 2/21/22 with diagnoses including Spinal Stenosis and Paroxysmal Atrial Fibrillation. Review of the Home Health Certification and Plan of Care dated 2/21/22 revealed orders for Physical Therapy 2 x a week for 6 weeks. A HV was conducted on 3/15/22 at 12:50 PM to observe care provided by EI # 11,Physical Therapist. EI # 9, Patient Care Manager, was also on the HV for observation. During the HV a review of the medications in the home were compared to the medication list provided to the surveyor on 3/15/22. Red Yeast Rice 600 mg dated 3/8/22 was in the home but not on the medication list. HV # 3 stated he/she had been taking the medication "for about 5 years". In an interview conducted on 3/15/22 at 1:50 PM, EI # 9, confirmed the medication was current but not on the Medication List. 1. HV # 1 was admitted to the agency on 2/8/22 with diagnoses including Arthritis Due to Other Bacteria, Vertebrae and Essential (Primary) Hypertension. A HV was conducted on 3/15/22 to observe Employee Identifier (EI) # 2, Registered Nurse perform a skilled visit. During the visit, the patient's medications were reviewed by the surveyor, EI # 2 and EI # 7, Patient Care Manager and compared to the Medicine List printed for the surveyor on 3/15/22 and the following discrepancies were observed: Loratadine 10 mg (milligram) tablet, one daily on the Medicine List and per HV # 1, "I don't take it that often. The last time was 6 months ago." Omeprazole 40 mg capsule, one capsule daily on the Medicine List and per HV # 1, "I stopped taking it 2 years ago." Ondansetron 4 mg disintegrating tablet, one every 8 hours as needed on the Medicine List and per HV # 1, "I have not taken it in about a year." Pennsaid 20 mg/gram/actuation (2%) Topical Solution in metered-dose pump topical 40 mg daily as needed on the Medicine List and per HV # 1, "I never had the medicine (in the home)." An interview conducted on 3/17/22 at 8:30 AM with EI # 1, Administrator confirmed the medication profile was not updated per agency policy. |