Assured Home Health

“Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This Element is not met as evidenced by: Based on agency policy and procedure, medical record review for Patient #1 and administrator interview conducted on March 22, 2024, the Department determined that the home health agency failed to ensure that communication and coordination occurred between the patient’s physician, infusion pharmacy staff, and the home health (HHA) skilled nursing (SN) team providing home care to the patient. The failure to communicate and coordinate orders between the three entities caused the failure by the home health agency to obtain specifically timed laboratory work from the patient for the physician’s evaluation of the effectiveness of the intravenous antibiotic treatment of the condition of sepsis. The agency job description entitled “ Executive Director” contained, “...Supervises and ensures high quality patient care services throughout the episode of care. This includes overseeing: referral coordination, assuring that patient needs are continually assessed and assuring the development implementation and updates of the patient’s individualized plan of care. Ensures coordination with physician, family and other clinicians involved in care as appropriate....” The agency policy entitled “Plan of Care” contained “...Each patient has an individualized Plan of Care (POC) developed in consultation with the patient, physician, or authorized practitioner and staff that integrates comprehensive assessment findings to address patient problems, needs and goals as well as to address specific services being provided....” Patient # 1’s medical record was reviewed. The review revealed that the patient was discharged from the hospital on February 9, 2024 with a midline catheter in her arm and orders to receive home health service to receive teaching and education on the self administration of intravenous antibiotics (three times daily) and SN cardio pulmonary assessment and teaching. The insurance company authorized the HHA to provide a skilled nursing visits at a frequency of 1 time a week for 9 weeks with 2 PRN (Pro Re Nata (as needed) ) visits for cardiac complications. The Plan of Care (POC) revealed “...SN to perform site care for infusion access device midline to left upper arm with transparent dressing changes 1 x (time) week and PRN for loose or soiled dressing using sterile technique cleanse site with chloraprep injection cap change once a week and with each lab draw and PRN for contamination or malfunction, extension tube change once a week and with each lab draw and PRN problems....” The POC failed to contain an order for the timing and frequency at which the lab draws were to be conducted. The SN Start of Care (SOC) for Patient #1 was conducted on February 10, 2024. The documentation revealed that the SN had conducted a comprehensive assessment which addressed OASIS E questions. Th OASIS E form addressed the question of whether labs were drawn on that visit. The answer was marked as no. The medical record further revealed that on February 13, 2024, the HHA received orders from the patient’s physician for “lab draws and blood cultures to be drawn today”. The SN informed the physician that the HHA was unable to draw the labs and blood cultures today due to receiving the orders late in the day and no available staff. It was documented that the Physician verbalized understanding and approved for the labs to be drawn on February 15, 2024. On February 15, 2024, the SN attempted to draw the patient’s labs and blood cultures after trying several different repositioning techniques. The SN was unable to obtain an adequate amount of blood for the specimens and the patient was sent to the Emergency Department on 02/19/2024. The Emergency Department (ED) removed the midline catheter and obtained the additional laboratory work. The ED was interviewed on March 22, 2024 and provided the following information. “...The MD office called the agency, requesting to add on orders, the CD (Clinical Director) spoke to the Infectious Disease provider and obtained Verbal Plan of Care approval, and blood cultures to be added to the weekly lab draws...Provider agreed for lab collection to be on 02/15/24...(On February 13) Patient called in to the agency informing them that a nurse is supposed to be coming to her home between 3-7 pm...The CD apologized and told the patient that it wasn’t our office that offered that time frame....” The ED stated that it was unknown who provided the incorrect information onto the patient, the ED stated that it may have been the physician’s office or the infusion company. The home health agency failed to communicate and coordinate with all individuals and companies involved in the patient’s care leading to a series of avoidable events that created stress and unnecessary hospital visits for the patient.”