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, observation, and interview, the home health provider failed to ensure staff maintained an accurate/updated medication profile in 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 record showed the patient was admitted to home health services on 04/23/2024. The patient had a history of extradural abscess (an infection in the space between the bones of the skull or spine and the membranes that cover the brain and spinal cord) and subdural abscess (a brain infection). Review of a physical therapy (PT) evaluation note dated 04/24/2024, showed the patient used acetaminophen (Tylenol) for pain. This was not included on the medication profile. Observation and interview on 05/13/2024 beginning at 12:10 PM, during the patient’s home visit, showed the following medication discrepancies with the provider’s medication profile: - The RN (registered nurse) reviewed the patient’s medications; - The medication profile showed an order for dextroamphetamine-amphetamine (a stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) 10 milligrams (mg) four tablets daily. The patient had a bottle dated 01/25/2024, of amphetamine 10 mg two in the morning and one at noon. The patient stated that he/she had taken this dosage about six months or longer; - The medication profile showed an order for metformin (diabetes medication) 500 mg one daily. The patient stated that he/she had not taken this in quite a while; - The medication profile showed an order for methocarbamol (muscle relaxant) 500 mg every eight hours. The patient had a bottle dated 05/06/2024, of methocarbamol 500 mg take one to two tablets three times a day as needed; - The medication profile showed an order for miralax (laxative) 17 grams daily. The patient stated that he/she had never gotten this to use; - The patient had a bottle of vitamin D3 (supplement) 25 micrograms (mcg) 1000 IU (international units). The patient stated that he/she had taken one once a day for about a month. The patient’s spouse stated that he/she had taken this for about a year. This was not included on the medication profile; and - The patient had a bottle dated 02/07/2024, of lactobacillus acidophilus (probiotic for gut health) one tablet once a day. The patient stated that he/she had taken this for at least a year. This was not included on the medication profile. During an interview on 05/29/2024, beginning at 1:15 PM, the area vice president of operations stated that if a patient was not taking a medication, he/she would not want it included on the medication list. The staff should visualize the medications at every visit. The administrator stated that staff should notify the physician if a patient was not taking a medication. The process was to go over all the medication bottles and compare to the discharge medication list and notify the physician of any discrepancies. If PT identified a new medication, they should contact the physician, write an order, update the medication profile, and let the clinical manager know. Findings included: Review of the provider’s policy titled, “Drug Regimen Review,” last revised 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; and - 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 05/16/2024 with a primary diagnosis of a fracture to the right hip, and diabetes (a condition of excess sugar in the blood).The patient lived at home with his/her spouse. Observation and interview on 5/28/2024 at 12:00 PM, during the patient’s home visit, showed the following medication discrepancies with the provider’s medication profile: -The medication profile showed an order for B-Complex tablet (a vitamin supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization; -The medication profile showed an order for Berberine Chloride 500 milligram (mg) capsule (a vitamin supplement), one capsule daily. The patient stated that he/she no longer takes the medication after her hospitalization; -The medication profile showed an order for Hydrocodone 10 mg - Acetaminophen 325 mg tablet (a narcotic pain reliever), one tablet every 6 hours as needed daily. The patient stated that he/she no longer takes the medication; -The medication profile showed an order for Kidney Activator tablet 830 mg (a dietary supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization; -The medication profile showed an order for Losartan 25 mg tablet (a medication to lower blood pressure), one tablet two times daily. The patient stated that he/she no longer takes the medication since 5/15/2024; -The medication profile showed an order for Magnesium Complex 300 mg (a vitamin supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization; -The medication profile showed an order for Probiotic 1 billion cell chewable tablet (a dietary supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization; -The medication profile showed an order for Turmeric Curcumin 1000 mg tablet (a dietary supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization; -The medication profile showed an order for Turmeric 750 mg tablet (a dietary supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization; -The medication profile showed an order for Vitamin C 250 MG tablet (a vitamin supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization; -The medication profile showed an order for Vitamin D3 125 micrograms (mcg) tablet (a vitamin supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization; and -The medication profile showed an order for Zinc Gluconate 50 mg tablet (a vitamin supplement), one tablet daily. The patient stated that he/she no longer takes the medication after her hospitalization. Additionally, the patient stated during the home visit he/she currently was taking the following medications which were in the home but were not listed on the current mediation list supplied by the provider; -The medication Tylenol 500 mg tablet (a non-narcotic pain reliever), one to two tablets as needed daily. The patient stated that this was used for his/her pain shorty after returning home from the hospital; and -The medication Pure Enzyme Ultra (a dietary supplement), one to two tablets as needed daily. The patient stated that he/she currently takes the medication. During an interview on 05/29/2024 at 1:30 PM, the administrator stated that the staff should follow the medication policy which directs the staff to compare all medications in the home to the medication list. Any discrepancies should be corrected by contacting the patient’s physician for clarification, and the patient’s current medication list should then be updated. RECORD/PATIENT #3: Review of the record showed the patient was admitted to home health services on 04/23/2024. The patient had a history of extradural abscess (an infection in the space between the bones of the skull or spine and the membranes that cover the brain and spinal cord) and subdural abscess (a brain infection). Review of a physical therapy (PT) evaluation note dated 04/24/2024, showed the patient used acetaminophen (Tylenol) for pain. This was not included on the medication profile. Observation and interview on 05/13/2024 beginning at 12:10 PM, during the patient’s home visit, showed the following medication discrepancies with the provider’s medication profile: - The RN (registered nurse) reviewed the patient’s medications; - The medication profile showed an order for dextroamphetamine-amphetamine (a stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) 10 mg four tablets daily. The patient had a bottle dated 01/25/2024, of amphetamine 10 mg two in the morning and one at noon. The patient stated that he/she had taken this dosage about six months or longer; - The medication profile showed an order for metformin (diabetes medication) 500 mg one daily. The patient stated that he/she had not taken this in quite a while; - The medication profile showed an order for methocarbamol (muscle relaxant) 500 mg every eight hours. The patient had a bottle dated 05/06/2024, of methocarbamol 500 mg take one to two tablets three times a day as needed; - The medication profile showed an order for Miralax (laxative) 17 grams daily. The patient stated that he/she had never gotten this to use; - The patient had a bottle of vitamin D3 (supplement) 25 mcg 1000 IU (international units). The patient stated that he/she had taken one once a day for about a month. The patient’s spouse stated that he/she had taken this for about a year. This was not included on the medication profile; and - The patient had a bottle dated 02/07/2024, of lactobacillus acidophilus (probiotic for gut health) one tablet once a day. The patient stated that he/she had taken this for at least a year. This was not included on the medication profile. During an interview on 05/29/2024, beginning at 1:15 PM, the area vice president of operations stated that if a patient was not taking a medication, he/she would not want it included on the medication list. The staff should visualize the medications at every visit. The administrator stated that staff should notify the physician if a patient was not taking a medication. The process was to go over all the medication bottles and compare to the discharge medication list and notify the physician of any discrepancies. If PT identified a new medication, they should contact the physician, write an order, update the medication profile, and let the clinical manager know.”