Amedisys Home Health of Missouri

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to ensure the plan of care was individualized to the specific needs of the patient in one of five full records reviewed (Record/Patient #1). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s policy titled, “Physician Orders and Medical Supervision of the Plan of Care,” dated 06/22/2023, showed each patient must receive an individualized written plan of care, including and revisions or additions. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to home health services on 01/26/2024 with a primary diagnosis of orthopedic aftercare following surgical amputation. The patient lived at home with his/her spouse. Review of the document titled “Home Health Certification and Plan of Care,” dated 03/26/2024, showed the patient was taking the following medications: -Aspirin (nonsteroidal anti-inflammatory and blood thinner) 81 milligrams (mg) chewable tablet, take one tablet daily with breakfast; and -Clopidogrel (an antiplatelet medication) 75 mg tablet, take one tablet daily in the morning. The plan of care failed to include interventions for antiplatelet medications. During an interview on 04/10/2024 at 3:00 PM, the administrator stated that he/she would expect the plan of care to include all interventions relative to the patient.”

“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 policy review, record review, observation and interview, the home health provider failed to ensure staff maintain an accurate and updated medication profile in, but not limited to, two of three home visit observations (Records/Patients #2 and #3). This deficient practice has the potential to affect all patients served by the provider. RECORD/PATIENT #3: Review of the clinical record showed the patient admitted to home health services on 01/05/2024 with a primary diagnosis of non-pressure chronic ulcer of the right foot. The patient lived at home with his/her spouse. Review of the document titled, “Medication List,” dated 04/09/2024, showed the patient was taking the following medications: -Acetaminophen 325 mg tablet, take two tablets two times daily; -Biotin (a B vitamin) 1 mg tablet, take one tablet daily, the patient was not taking this medication; -Citalopram (used to treat depression, including major depressive disorder) 20 mg tablet, take one tablet daily, the patient was not taking this medication; -Ferrous Sulfate 325 mg (65 mg iron) tablet, take one tablet daily; -Lactobacillus Acidophilus (used for diarrhea from antibiotics) one billion cell tablet, take one tablet two times daily, the patient was not taking this medication; -Levothyroxine (used to treat an underactive thyroid gland) 25 micrograms (mcg) tablet, take one tablet daily; -Macrodantin (used to treat infections of the urinary system caused by bacteria) 100 mg capsule, take one capsule daily, the patient was not taking this medication; -Pantoprazole (reduces the amount of acid your stomach makes) 40 mg tablet, take one tablet daily, the patient was not taking this medication; -Prednisone (used to treat many diseases and conditions, especially those associated with inflammation) 20 mg tablet, take one tablet as directed, the patient was not taking this medication; and -Vitamin D3 10 mcg (400 unit) capsules, take one capsule daily. Observation on 04/10/2024 at 2:00 PM, during the patient’s home visit, showed the patient was taking the following medications: -Acetaminophen 500 mg tablet, take two tablets one time daily as needed; -Ferrous Sulfate 325 mg (28 mg iron) tablet, take one tablet daily; -Levothyroxine 50 mcg tablet, take one tablet daily; -Vitamin D3 5000 unit capsule, take one capsule daily; -Fish oil 2400 mg capsule, take one capsule two times daily, this medication was not on the provider’s medication list; -Probiotic 2 billion cell capsule, take one capsule once daily, this medication was not on the provider’s medication list; and -Omeprazole 20 mg capsule, take one capsule daily, this medication was not on the provider’s medication list. During an interview on 04/10/2024 at 3:00 PM, the home health administrator stated that he/she would expect all medications on the medication list to match what the patient was taking. Review of the provider’s policy titled, “Drug Regimen Review,” last revision dated December 1, 2023, showed, in part: - The purpose of the policy is to identify appropriateness, inconsistencies and /or significant drug interactions as well as ensure a comprehensive list of medications are updated any time there is a medication change including dose change, new medications, and any medications discontinued. - A copy of the Medication Profile is taken to the patient’s home and placed in the patient’s home folder and incorporated in the medical record. RECORD/PATIENT #2: Review of the clinical record showed the patient admitted to home health services on 01/17/2024 with a primary diagnoses of falls and Osteoarthritis (a condition in which the body’s joints break down over time).The patient lived at home alone. Observation and interview on 04/10/2024 at 9:40 AM, during the patient’s home visit, showed the following medication discrepancy, the provider’s medication profile showed an order for Cefdinir (an antibiotic used to treat infection), 300 milligrams (mg), take one capsule two times daily. The patient’s stated that he/she was no longer taking the medication, and the medication bottle was no longer in the home. Review of the patient’s active medical record showed an order dated 03/12/2024 to 03/17 /2024 for Cefdinir 300 (mg), take one capsule two times daily for five days. During an interview on 04/10/2024 at 2:30 PM, the administrator stated the medication, “should have been taken off the active medication profile”.”

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on policy review, observation, and interview, the home health provider failed to ensure an accurate and visit schedule was placed in the patient’s home folder in one of three full records reviewed (Record/Patient #3). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s policy titled, “Patient Rights and Responsibilities,” dated 04/04/2023, showed, in part, the patient has the right to be informed about the disciplines that will furnish care and the frequency of visits. RECORD/PATIENT #3: Review of the clinical record showed the patient admitted to home health services on 01/05/2024 with a primary diagnosis of non-pressure chronic ulcer (caused by poor circulation, which in turn is caused by venous or arterial insufficiency) of the right foot. The patient lived at home with his/her spouse. Review of the document titled, “Home Health Certification and Plan of Care,” dated 03/05/2024-05/03/2024 showed the patient was ordered skilled nurse (SN) visits as follows: - One time a week for one week; - Two times a week for two weeks; - One time a week for 6 weeks; and - Two PRN (pro re nata - as needed) visits for signs and symptoms of infection. Observation on 04/10/2024 at 2:00 PM, during the patient’s home visit, showed the home folder contained a blank calendar. The home folder failed to contain the discipline visit frequency. During an interview on 04/10/2024 at 3:00 PM, the administrator stated that he/she would expect the visit schedule to be contained in the patient’s home folder.”