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 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)
G0578 Conformance with physician orders
CFR(s): 484.60(b)

Standard: Conformance with physician or allowed practitioner orders.


This STANDARD is not met as evidenced by:
Based on review of Medical Records (MR), agency policies and procedures and staff interviews it was determined the agency failed to ensure physician orders were followed for pulse oximetry, visit frequency, and wound care.




This deficient practice did affect 3 of 17 MRs reviewed including, MR # 4, MR # 8, and Home Visit (HV) # 6 and had the potential to affect all patients served by the agency.



Findings include:



Agency Policy: Plan of Care (POC)




Policy Number: 2.1.007




Revised Date: 12/1/21




Purpose: ...To ensure that physician/authorized practitioner's orders are followed.




...Procedure:




...2. The POC includes:




...All patient care orders...




Agency Policy: The Role of the Physician




Policy Number: 5.011




Revised Date: 11/1/21




...Procedure:




...2...a. The agency's responsibilities to the physician:




I. provides services to the patient only as ordered by the physician.




Agency Policy: Dressing Change Procedure for Central Venous , Midline, and Peripherally Inserted Central Catheters




Policy Number: 10.027




Revised: 10/01/2016




...Procedure:




... 9. Cleanse the site with chlorhexidine (preferred) in a back and forth motion for at least 30 seconds. If povidone-iodine is used, use swabs to apply in a circular motion...





3. HV # 6 was admitted to the agency on 2/28/22 with diagnoses including Hypertensive Heart Disease, Heart Failure, and Encounter for Adjustment and Management of Vascular Access Device.




Review of the HHC and POC dated 2/28/22 revealed orders including for the Skilled Nurse to perform site care for infusion access device to the right arm midline site weekly using sterile technique "cleanse site with alcohol swabs x 3..."




Review of the Visit Note Reports dated 3/8/22 and 3/14/22 revealed the nurse documented the infusion access site was "cleansed with Betadine swabs x 3 followed by alcohol swabs x3..."




There was no order documented to cleanse the site with Betadine.




In an interview conducted on 3/17/22 at 9:30 AM EI # 8, PCM, confirmed there was no order documented for the use of Betadine.










1. MR # 4 was admitted to the agency on 1/14/22 with diagnoses including Aftercare following Joint Replacement surgery, Essential (Primary) Hypertension, and Dependence on Supplemental Oxygen.




Review of the Home Health Certification (HHC) and POC dated 1/14/22 to 3/14/22 revealed documentation of a Physical Therapy (PT) frequency of 1wk1, 3wk1,1wk1 (once a week for 1 week, three times a week for 1 week) and a physician's order for "PT to perform pulse oximetry each visit in order to monitor patients respiratory status."




Review of the PT Visit Note Reports (VNR) dated 1/14/22, 1/19/22 and 1/21/22 revealed no documentation a pulse oximetry reading was obtained.




An interview was conducted on 3/16/22 at 3:51 PM with Employee Identifier (EI) # 7, Patient Care Manager (PCM), who confirmed there was no documentation a pulse oximetry reading was obtained on the above dates.




2. MR # 8 was admitted to the agency on 2/19/22 with diagnoses of Encounter for Orthopedic Aftercare following Surgical Amputation, Type 2 Diabetes with Diabetic Peripheral Angiopathy without Gangrene and End Stage Renal Disease.




Review of Client Coordination Note Report revealed documentation dated 2/17/22 the patient went to dialysis on Monday, Wednesday and Friday of each week




Review of the HHC and POC dated 2/19/22 to 4/19/22 revealed a Skilled Nurse (SN) frequency of once a week for 9 weeks and a physician order for the "SN to assess wound VAC (Vacuum-assisted closure) dressing. No wound care/wound vac orders at this time. Patient to follow up with (physician identified)...on 2/22/22..."




Review of the Client Coordination Note Reports revealed documentation of SN attempted visit on Friday 2/25/22 (week of 2/20/22 to 2/26/22) and Friday 3/4/22 (week of 2/27/22 to 3/5/22). There was no documentation the SN attempted to scheduled a visit for a day the patient was not at dialysis and/or reschedule the SN visit for the weeks of 2/20/22 to 2/26/22 and 2/27/22 to 3/5/22.




An interview was conducted on 3/16/22 at 3:59 PM with EI # 7, who confirmed there was no documentation the SN attempted to complete the physician ordered visits for the above week on a day when the patient did not have dialysis and/or attempted to reschedule the SN visits.