| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017037 | (X3) Date Survey Completed 10/10/2018 |
| Name of Provider or Supplier Alabama Homecare Of Montgomery, Llc | Street Address, City, State 400 South Union Street Suite 285, Montgomery, 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 orders. This STANDARD is not met as evidenced by: Based on review of medical records (MR), agency policy and procedures, and interviews with agency staff, it was determined the agency failed to ensure wound care was provided according to physician orders This affected 3 of 6 records reviewed with wounds including, Home Visit (HV) # 1, MR # 2, and MR # 1 and the potential to negatively affect all patients served by the agency Findings include: Policy: 2.2.001 Subject: Wound Assessment, Documentation, and Photography Revised: 9/1/2017 Purpose: To ensure the accurate and consistent assessment and documentation of wounds Procedure: ...2. Perform wound care according to LHC adopted clinical skills guidelines and physician orders... ...4. Redress the wound using appropriate wound care dressing procedure following physician orders... Policy: 2.2.007 Subject: Negative Pressure Wound Therapy (NPWT) Revised: 9/1/17 Purpose: To promote wound healing and establish competency assessment guidelines when utilizing negative pressure wound therapy. Policy: The RN (Registered Nurse) performs a wound assessment at least once a week during therapy... Procedure: 2. Perform procedure utilizing LHC adopted clinical guidelines... 4. The clinician will document the number of foam/sponge pieces placed in the wound bed and the number of foam/sponge pieces removed from the wound... 1. HV # 1 was admitted to the agency on 8/27/18 with diagnoses including, Encounter for Orthopedic Aftercare Following Surgical Amputation. Review of the Physician Order dated 8/29/18 revealed the following physician's order: "SN (skilled nurse) to perform wound care with KCI (company that supplies the Negative Pressure Device) Negative Pressure Device to # 2 Right Transmetatarsal Surgical Amputation site 3X (3 times) weekly as follows: Cleanse wound with wound cleanser and gauze. Gently pat dry with gauze. Prepare periwound area with skin protectant. Cover wound with contact layer then fill entire cavity with black foam. In tunneled/undermined areas apply white foam. Cover with transparent drape and apply tubing. Apply negative pressure device at 125 mmHg (Millimeters of Mercury) continuous..." Review of the Visit Note Report(s) dated 9/14/18, 9/17/18, 9/19/18, and 9/21/18 revealed no documentation of what wound care was provided by the SN at the visit. Review of the Physician Order dated 9/25/18 revealed the following physician's order: "SN to perform/instruct/reinforce wound care to # 2 (Diabetic) Distal Dorsum Right Foot Transmetatarsal Surgical Amputation site 3 x week (3 times a week) as follows: Cleanse with wound cleanser and gauze. Gently pat dry. Apply Lotion to affected Extremity. Apply Prisma to wound. Cover with Xeroform. Cover with gauze and ABD (abdominal) pad. Wrap with cotton followed by Kerlix and secure with paper tape..." Review of the of the Visit Note Report(s) dated 9/26/18 and 9/28/18 revealed no documentation of what wound care was provided by the SN at the visit. An interview was conducted on 10/10/18 at 1:19 PM with Employee Identifier (EI) # 1, Executive Director, who confirmed the previous findings. 2. MR # 2 was admitted to the agency on 7/25/18 with diagnoses including Type 2 Diabetes Mellitus with Diabetic Polyneuropathy and Non-Pressure Chronic Ulcer of Left Heel and Midfoot with Fat Layer Exposure. Review of the Physician Order dated 8/6/18 revealed order for "SN to provide negative pressure wound therapy to Left Foot wound: Using Aseptic technique, cleanse wound with wound cleanser. Apply skin prep to peri wound area and windowpane wound edges with transparent drape. Apply adaptic to wound bed, cover with black foam. Bridge to top of foot and apply trac pad. initiate vacuum at 125 continuous. Secure with kerlix and tape..." Review of the Visit Note Report(s) dated 8/6/18, 8/8/18, 8/10/18, 8/13/18, 8/15/18, 8/17/18, 8/20/18, and 8/22/18 revealed documentation of wound care to wound # 1 Lt (left)-Mid Plantar, Diabetic Ulcer provided as, "SN performed negative pressure wound therapy to left foot using aseptic technique. applied skin prep and drape to wound edges and applied adaptic to wound bed. Covered with black foam and bridged to top of foot and applied trac pad. Suction at 125 continuous. Secured with kerlix and tape..." Further review of the Visit Note Report(s) dated 8/6/18, 8/8/18, 8/10/18, 8/13/18, 8/15/18, 8/17/18, 8/20/18, and 8/22/18 revealed no documentation of what was used to cleanse wound # 1. An interview was conducted on 10/10/18 at 1:44 PM with EI # 1, who confirmed the previous findings. 3. MR # 1 was admitted to the agency on 8/1/18 with admitting diagnoses of Abcess of The Breast and Nipple and Cellulitis of Other Sites. Review of the Home Health Certification and Plan of Care dated 8/1/18 revealed the following Physican order: Skilled Nurse to cleanse wound with wound cleanser and pat dry. Prepare periwound area with skin prep and window pane wound edges with transparent drape. Apply white foam in tunneled/undermined areas, then cover with black foam. Cover with transparent drape and apply trac pad/tubing. Initiate negative pressure device at 125 mm/Hg (millimeters of mercury) continuous. Dressing to be changed twice a week... Review of the SN visit note dated 8/3/18 revealed the documentation in the wound assessment section of the note stated patient had wound # 1 to left upper inner quad of breast,Abcess. Review of the documentation in the wound assessment section of the note dated 8/3/18 revealed the SN documented wound assessed: no, wound care provided: wound care not provided: not ordered this visit and no wound measurements were documented. Further review revealed in the narrative section of the note the SN documented wound care provided and completed. Review of the wound care assessment and the narrative section of the note revealed no documentation of how the wound care was provided and how many pieces of white and black foam was removed or applied. Review of the SN visit note dated 8/7/18 revealed the documentation in the wound assessment section of the note stated wound assessed: No, awaiting orders, wound care provided: wound care not provided awaiting orders and no documentation of wound measurements. Review of the narrative section of the note revealed the SN attempted to do wound care, SN could not find 2nd white foam. RN notified and team leader will come to the patient's house. Review of the Client Coordination Note Report dated 8/7/18 revealed the SN documented the white foam was removed and wound care completed per orders and wound vac placed at 125 mm/Hg. Review of the documentation revealed the SN failed to document the actual wound care provided and the number of white and black foam pieces removed or applied to the wound. Review of the SN visit note dated 8/9/18 revealed in the wound assessment section of the note the SN documented applied white foam in tunneled/undermined areas, then covered with black foam. The SN failed to document the actual wound care provided and the number of white and black foam pieces removed or applied. Review of the SN visit note dated 8/13/18 revealed in the wound assessment section of the note the nurse documented applied white foam in tunneled/undermined areas, then covered with black foam. Further review revealed no documentation as to how many pieces of white foam and black foam were removed or applied. Review of the SN visit note dated 8/14/18 revealed the nurse documented applied white foam in tunneled/undermined areas, then covered with black foam. Further review revealed no documentation as to how many pieces of white and black foam were removed or applied. Review of the SN visit note dated 8/16/18 revealed the nurse documented in the wound assessment section the patient had developed a second wound to the left breast. Wound assessment was complete with measurements of wound # 2. Review of the wound assessment section of the note revealed the nurse documented applied white foam in tunneled/undermined areas, then covered with black foam. Further review revealed no documentation as to how many pieces of white and black foam were removed or applied and no documentation of wound measurements for wound # 1. Review of the SN visit note dated 8/24/18 revealed the nurse documented in the wound assessment section applied white foam in tunneled/undermined areas, then covered with black foam. Further review revealed no documentation as to how many pieces of white and black foam were removed or applied. Review of the SN visit note dated 8/29/18 revealed the nurse documented in the wound assessment section applied white foam in tunneled/undermined areas, then covered with black foam. Further review revealed no documentation as to how many pieces of white and black foam were removed or applied and no documentation the nurse measured wound # 2 and stated under measurements taken: No and Reason for measurements not taken: documented unable. Review of the SN visit note dated 8/31/18 revealed no documentation of wound measurements for wound # 2. An interview was conducted on 10/10/18 at 1:30 PM with EI # 1 who confirmed the above mentioned findings. |