Epic Homecare Inc.

“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 observation, interview and record review the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to maintain a current medication profile and check the medication’s expiration dates for two of 13 sampled patients (Patients 3 and Patient 7). The deficient practice had the potential to placed Patients 3 and Patient 7 at risk for medication errors and ineffective treatment from expired mediation. Findings: b. A review of Patient 7’s Patient information sheet indicated a start of care (SOC) date of 9/13/2023. A review of Patient 7’s Plan of Care (POC), for the certification period from 11/12/2023 to 1/10/2024, indicated a start of care (SOC) date of 9/13/2023 with diagnoses that included encounter for change or removal of nonsurgical wound dressing and venous insufficiency (Improper functioning of the vein valves in the leg, causing swelling and skin change). The POC indicated a Skilled Nurse to visit twice a week for one, three times a week for two weeks, once a week for six weeks and to reassess after two weeks. The POC indicated a Physical Therapy evaluation. A review of Patient 7’s Medication Profile indicated for Furosemide (a medication used to used to treat fluid retention [edema]) 20 milligram (mg, unit of measurement), one tablet daily for fluid retention. On 1/3/2024 at 11 a.m., a joint home visit with the Physical Therapist (PT 2) was conducted at Patient 8’s residence. Patient 8 was alert, oriented and sitting on the sofa in the living room. PT 2 performed vital signs and physical therapy exercises with Patient 7. During a concurrent observation and interview on 1/3/2024 at 11:30 a.m., with PT 2, Patient 7’s medications were reviewed. There was no bottle observed for Furosemide. PT 2 stated that the nurse was at the house on 1/1/2024 and ordered the medication. During an interview on 1/4/2024 at 3:25 p.m., the Director of Patient Care Services (DPCS) stated that the visiting nurse is supposed to check the medications every visit to make sure the patient has it available and to check if there is any changes. The DPCS stated if there are changes, they will call the case manager to update the medications profile. The DPCS stated that it was important to have the medications on hand and available because the patient needs to take it daily. A review of home health agency’s policy and procedure titled, “Medication Profile”, dated 04/2021, indicated that patients receiving medications will have a current, accurate medications profile in the clinical record. The policy indicated that medication profile will be updated for each change to reflect current medications and new and/or discontinued medications. a. A review of Patient 3’s Plan of Care (POC: document that details the the type of care the patient is to receive from the agency) indicated a start of care (SOC) date of 1/24/2023, with a primary diagnosis of hypertensive heart disease (high blood pressure) and chronic kidney disease (kidneys are damaged and cannot filter blood properly) with heart failure (when the heart cannot pump enough blood for the body’s needs). According to the POC they patient was to have skilled nursing visits once a week for nine weeks and the nurse was to access medication compliance, educate the patient/caregiver on medication actions, uses, frequency, dose, side effects, interactions with all meds as needed with emphasis on new/changed meds. On 1/3/2024, at 2:04pm, a home visit was conducted at Patient 3’s home with Physical Therapist Assistant 2 (PTA 2) and Patient medications were reviewed. The following discrepancies were found… 1. Creon (a medication used to treat people who cannot digest food normally to help break down and digest fats, starch, and proteins in food) 12,000-38,000 units. Take one capsule by mouth three times a day with meals. Pharmacy fill date 12/15/23. This medication was not listed on the medication profile. 2. Spiriva inhaler (a medication that relaxes the muscles around the airway so that they open up and you can breathe more easily) 18 micrograms (mcg: unit of measurement). This medication was not on the medication profile and there was no pharmacy label on the medication box. 3. Azelastine HCL (a nasal spray that is used to treat runny or stuffy nose, itching, sneezing and itchy, watery eyes) nasal solution 0.1%. This medication was not on the medication profile and there was no pharmacy label on the medication box. The box did not specify how much spray to use. 4. Flonase (a nasal spray that is used to treat runny or stuffy nose, itching, sneezing and itchy) nasal spray. 50 mcg per spray. This medication was not on the medication profile. The box did not specify how much spray to use. 5. Tramadol HCL (a controlled pain medication) 50 milligram (mg: unit of measurement) tablet. Take 1 tablet as needed (PRN) every 4-6 hours. This medication expired on 12/12/2020. 6. Torsemide (a medication to help take excess fluid out of the body) 5 mg take one tablet twice a day. The directions on the patient’s bottle indicated to take the medication every two days. During an interview on 1/3/2024, at 2:30pm, Patient 3’s caregiver (CG 1) stated that Patient 3 was no longer taking the Tramadol and has not taken it for months. CG 1 stated that he cannot remember when the last time he filled the prescription for Spiriva and the nasal sprays, but it has been a couple of weeks. A review of Patient 3’s medication profile for certification period 11/24/2023 to 1/22/2024, indicated that the last drug regimen review was done on 11/24/2023. During an interview on 1/4/2024, at 3:30pm, the Director of Patient Care Services (DPCS) stated that the nurses are supposed to check meds every visit. The nurses can call the case manager or update med profile and order the medications themselves. The nurses are supposed to ask the patient if they are taking anything new and verify with actual medications bottle and medication profile. The DPCS stated that they need to know what medications the patients are taking for their safety, because they can have side effects or drug interactions.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on interview and record review, the home health agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to follow their discharge policy by not completing a discharge summary for one of 13 patients (Patient 13). This deficient practice had the potential to affect the patient’s outcome and post discharge instructions. Findings: A review of Patient 13’s Patient information sheet indicated a start of care (SOC) date of 6/26/2023. A review of Patient 13’s Plan of Care (POC), for the certification period from 10/24/2023 to 12/22/2023, indicated a start of care (SOC) date of 6/26/2023 with diagnoses that included a Stage 3 (full thickness tissue loss) pressure injury (the breakdown of skin integrity due to pressure) to the left hip. The POC indicated a Skilled Nurse to visit twice a week for four weeks and then once a week for four weeks. The POC indicated for a Physical Therapy evaluation. During an interview and record review on 1/4/2023 at 3:13 p.m., with the Director of Patient Care Services (DPCS), the DPCS reviewed Patient 13’s Agency Discharge/Transfer Summary dated 12/4/2023. The discharge/transfer summary indicated that the reason for discharge/transfer as admitted to skilled nursing (SN) facility and the discharge instructions provided section was left blank. The DPCS stated that it was an error, the patient was transferred to hospice, not an SN facility. The DPCS stated the discharge summary should indicated that the patient was transferred to a hospice agency and the name of the agency where the patient was transferred. The DCPS stated that discharge instructions should had been included in the discharge summary to ensure continuity of care. A review of the HHA’s policy titled “Discharge Criteria and Process,” dated 4/2021 indicated that for a patient requiring continuing care, assistance will be given to the patient and family/caregiver in order to manage continuing care needs after the organization’s services and discontinue. Discharge instructions will be provided. A review of the HHA’s Policy titled, “Discharge Summary,” dated 4/2021 indicated that each clinician who provides care will complete a discharge summary at the time his/her discipline is discharged, which may include, as appropriate: …C. The reason for discharge, including, as applicable, the name of the organization to which the patient is being transferred.”