Amedisys Home Health of Missouri

“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, and interview, the home health provider failed to ensure an accurate and updated medication profile was included in the patient record in one of five full records reviewed (Record/Patient #2). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s policy titled, “Drug Regimen Review,” dated 12/01/2023, showed the clinician will question the patient and/or caregiver periodically regarding changes in medications including dosage changes, any new medications added, or any medications discontinued. RECORD/PATIENT #2: Review of the clinical record showed the patient admitted to home health services on 05/12/2024 with a primary diagnosis of Parkinson’s disease (a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves). Observation and interview on 06/10/2024 beginning at 1:15 PM, during the patient’s home visit, showed the following medication discrepancies: -The medication profile showed an order for Acetaminophen (used to treat mild pain) 500 milligram (mg) tablet, take two tablets three times daily as needed. The patient stated that he/she took two tablets four times daily as needed; -The medication profile showed an order for Acidophilus (a probiotic) chewable tablet, take one tablet three times daily. The patient stated that he/she took one tablet once daily; -The medication profile showed an order for Baclofen (used to treat muscle spasms) 10 mg tablet, take 0.5 tablets twice daily and 1 tablet at night. The patient stated that he/she took one tablet three times daily; -The medication profile showed an order for Carbidopa 25 mg- Levodopa 100 mg tablet (used to treat Parkinson’s disease), take one tablet three times daily. The patient stated that he/she took 1.5 tablets three times daily; -The medication profile showed an order for Cholecalciferol (Vitamin D3) 125 microgram (mcg) tablet, take one tablet daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Ciprofloxacin (used to treat infection) 500 mg tablet, take one tablet every 12 hours. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Colestipol (used to treat high cholesterol) 1 gram tablet, take one tablet two times daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Cyanocobalamin (Vitamin B-12) 1000 mcg tablet, take one tablet daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Ergocalciferol (Vitamin D2) 1250 mcg capsule, take one capsule weekly. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Ferrous Sulfate (iron) 325 mg tablet, take one tablet daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Leflunomide (used to treat arthritis) 20 mg tablet, take one tablet daily. The patient stated that he/she took 10 mg once daily; -The medication profile showed an order for Lidocaine (used to treat pain) pain relief 4% topical patches as needed daily. The patient stated that he/she no longer used this medication; -The medication profile showed an order for Propranolol (used to treat high blood pressure) 20 mg tablet three times daily. The patient stated that he/she took 80 mg once daily; -The medication profile showed an order for Saccharomyces Bouldardii (probiotic) 250 mg capsule, take one capsule daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Sucralfate (used to treat acid reflux) 100mg/milliliter (mL) oral suspension, take 10 mL every 6 hours. The patient stated that he/she took 1 gram tablets three times daily; -The medication profile showed an order for Sulfamethoxazole 800 mg- Trimethoprim 160 mg tablet (used for urinary tract infection prevention), take one tablet at bedtime. The patient stated that he/she no longer took this medication; and -The medication profile showed an order for Vancocin (used to treat infections) 125 mg capsule, take one capsule four times daily for eight days, take one capsule twice daily for seven days, take one capsule daily for seven days, then discontinue. The patient stated that he/she no longer took this medication. Additionally, the patient stated during the home visit he/she was currently taking the following medications which were in the home but were not listed on the current mediation list supplied by the provider; -The medication Azathioprine (an immuno-suppressant) 50 mg tablet once daily; -The medication Famotidine (used to treat stomach and throat problems) 40 mg tablet once daily; -The medication Fludrocortisone (a corticosteroid) 0.1 mg tablet once daily; -The medication Macrobid (used to treat infections) 100 mg tablet twice daily for 10 days; and -The medication Potassium (a vitamin) 10 milliequivalents (mEq) tablet once daily. During an interview on 06/11/2024 at 2:05 PM, the administrator stated that he/she would expect the medications to be reconciled and match what the patient is currently taking.”

“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 policy review, record review, and interview, the home health provider failed to send a transfer/discharge summary to the receiving provider in one of two discharge records reviewed (Record/Patient #6). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s policy titled, “Discharge of Patient,” dated 05/23/2024, showed the home health provider must send all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences, to the receiving facility to ensure the safe and effective transfer of care. RECORD/PATIENT #6: Review of the clinical record showed the patient was admitted to home health services on 04/25/2024 with a primary diagnosis of protein-calorie malnutrition. Review of the communication note dated 05/07/2024 showed the patient’s spouse planned to take the patient to the hospital related to pain level and low oxygen saturation. Review of the communication note dated 05/09/2024 showed the patient was admitted to [named hospital] on 05/07/2024 for end stage renal disease and hypertension. During an interview on 06/11/2024 at 2:05 PM, the administrator stated that he/she did not have a discharge summary for the patient. The administrator also stated he/she spoke with the staff regarding the need for discharge summaries and will be doing agency training regarding the need for the discharge summaries.”