Amedisys Home Health of the Midlands

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on record review, policy and procedure review, observation of the provision of care, and staff interview, the agency failed to ensure 4 of 7 staff (Staff F, G, H, and I ), observed during the provision of care for 4 of 7 patients (Patient 4, 5, 6, and 7 ), performed proper hand hygiene, bag technique and cleaning of equipment, according to the agency’s policies and procedures. The total sample size was 17. The census was 177. Findings are: A. Review of the agency’s policy and procedure titled Hand Hygiene, PCP-001, reviewed 6/26/24, revealed: 1.Staff were to perform hand hygiene before and after having direct contact with patients. 2. Before applying gloves. 3. After contact with a patient’s intact skin. 4. After removing gloves. 5. Gloves were to be changed during patient care. B. Review of the agency’s policy and procedure titled Bag Technique, PCP-002, reviewed 6/26/24, revealed hands were to be sanitized prior to entering the nursing bag. C. Review of the agency’s policy and procedure titled Bath Shower, PC-002, reviewed 3/26/24, revealed: 1.Gloves are to be worn during the shower. 2. A separate washcloth was to be used for the perineum. 3. Gloves were to be removed, and hand hygiene was to be performed after patient care. D. Review of the agency’s policy and procedure titled Decontamination of Re-usable Equipment, PCP-003, reviewed 6/26/24, revealed: 1.Blood pressure cuffs, pulse oximeters, stethoscopes, and scales, were to be cleaned with an 70% isopropyl alcohol or an agency approved, single use disinfectant wipe, after each use. 2. Scales were to be cleaned prior to use, and all external surfaces were to be cleaned after use prior to being removed from the home, with an agency approved disinfectant. E. Review of clinical records revealed: 1.Patient 4’s Home Health Certification and Plan of Care (POC), for the certification period 12/23/24 through 2/20/25, included orders for a Home Health Aide, 2 times weekly, to assist with personal care, hygiene and activities of daily living. 2. Patient 5’s POC, for the certification period 11/28/24/through 1/26/25, included orders for Skilled Nursing (SN), 1 time weekly, to provide wound care. 3. Patient 6’s POC for the certification period 11/13/24 through 1/11/25, included orders for Physical Therapy (PT), 1 time weekly, for gait training and therapeutic exercises. 4. Patient 7’s POC for the certification period 12/7/24 through 2/4/25, included orders for SN, 1 time a week, to obtain intravenous (IV) access via implanted port, IV port cares, and draw lab via IV implanted port F. During the observation of the provision care for Patient 4 on 1/2/25 at 2:30 PM, Staff F failed to: 1.Sanitize hands before having direct contact with the patient. 2. Sanitize hands prior to entering the nursing bag on 2 separate occasions. 3. Wear gloves while providing a shower and washing the perineum. 4. Use a separate washcloth for washing the perineum. 5. Sanitize hands after completing patient care. 6. Sanitize the electronic tablet after documenting cares and having the patient electronically sign on the tablet. G. During the observation of the provision of care for Patient 5 on 1/6/25 at 11:00 AM, Staff G failed to: 1.Sanitize hands prior to putting on gloves, prior to performing wound care. 2. Sanitize hands prior to entering the nursing bag to return clean equipment. 3. Sanitize the electronic tablet after documenting cares and having the patient electronically sign on the tablet, prior to returning the tablet into the nursing bag. H. During the observation of the provision of care for Patient 6 on 1/6/25 at 9:00 AM, Staff H failed to clean reusable equipment, with a single use disinfectant wipe, after using the equipment and prior to returning the equipment into the nursing bag. I. During the observation of the provision of care for Patient 7 on 1/6/25 at 1:25 PM, Staff I failed to: 1.Sanitize hands, on 1 occasion, prior to entering the nursing bag. 2. Clean the scale, prior to placing it on the patient’s floor. 3. Failed to sanitize all external surfaces of the scale after use. J. During an interview on 1/15/25 at 12:00 PM, the Administrator confirmed Staff F, G, H, and I failed to follow the agency’s policies and procedures for proper hand hygiene, bag technique, and cleaning of equipment, during the provision of care for Patient 4, 5, 6, and 7.”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to ensure the patient’s medication orders on the Plan of Care and the medication profile (a real-time document used by the agency that lists the patient’s medications) were accurate for 8 of 17 patient records reviewed (Patient 1, 3, 5, 7, 8, 9, 10, 11). The total sample size was 17. The census was 177. Findings are: A. Review of the agency’s policy and procedure titled Drug Regimen Review (Home Health Only), MA-002, reviewed 12/9/24, revealed: 1.The clinician was to perform a medication reconciliation by reviewing the discharge paperwork for patients being admitted/resumed from acute or post-acute facilities on admission, recertification, resumption of care and with any major change in condition. 2.The clinician was to contact the patient’s physician to verify, receive/write subsequent orders, and amend the medication profile as indicated, when problems/concerns were noted. 3. During the review of the discharge paperwork from the facility, the clinician was to assure all medications were included with correct dosages. 4. Visualized medications in the home were to be compared to the current medication profile to ensure accuracy of the medication profile. Any discrepancies were to be clarified with the patient’s physician and documented in the clinical record. 5. Medication changes or additions were to be received from the physician verbally, and a supplemental order was to be completed. B. Review of Patient 1’s clinical record revealed: 1.Discharge documents from Methodist Health System, dated 12/12/24, included orders for Saliva substitute (used to relieve dry mouth), Loperamide (used to treat loose stools), and Docusate Sodium (stool softener). 2. The Home Health Certification and Plan of Care (POC) for the certification period 11/28/24 through 1/26/25, and the medication profile, dated 12/30/24, failed to include Saliva substitute, Loperamide, or Docusate Sodium. 3. There was no documentation in the clinical record, that the physician was notified of the medication discrepancies. C. Review of Patient 3’s clinical record revealed: 1.Discharge orders from Life Care Centers of America, dated 11/27/24, included orders for Bisacodyl suppository (used for constipation), Colace (stool softener), Deep Sea Nasal Spray (used for dry nasal passage), Docusate Rectal Enema (used for constipation), Fleet Enema (used for constipation), Glucagon (used for low blood sugar), Glucose Tabs (used for low blood sugar), Lidocaine External Gel (used to numb and relieve pain), Liquacel oral liquid (protein supplement), Lomotil (used for loose stools), Milk of Magnesia (used for constipation), and Multivitamin (supplement). 2. The POC for the certification period 12/1/24 through 1/29/25, and the medication profile, dated 12/31/24, failed to include Bisacodyl suppository, Colace , Deep Sea Nasal Spray, Docusate Rectal Enema, Fleet Enema, Glucagon, Glucose Tabs, Lidocaine External Gel, Liquacel oral liquid, Lomotil, Milk of Magnesia, and Multivitamin. 3. There was no documentation in the clinical record, that the physician was notified of the medication discrepancies. D. Review of Patient 5’s clinical record revealed: 1.The Order Summary Report from Old Mill Rehabilitation, dated 11/22/24, included order for MiraLAX (used for constipation), Senna tab (used for constipation), and Systane Ointment (used for dry eyes). 2. The POC for the certification period 11/28/24 through 1/26/25, and the medication profile, dated 1/8/25, failed to include MiraLAX, Senna, and Systane. 3. There was no documentation in the clinical record that the physician was notified of the medication discrepancies. E. Review of Patient 7’s clinical record revealed: 1.The agency received an order on 12/13/24, from the patient’s physician, to hold Statin (used to lower cholesterol), while patient was on IV (intravenous) Daptomycin (used to treat infection) therapy. 2. The agency failed to discontinue the Statin on the medication profile. F. Review of Patient 8’s clinical record revealed: 1.Orders from VA Nebraska-Western Iowa Health Care System, Home and Community Based Services, dated 10/23/24, included orders for Albuterol inhaler (used for shortness of breath), Nitroglycerin (used for chest pain), Olodaterol/Tiotrop inhaler (used for shortness of breath), and Trospium (used for urine incontinence), 20 milligrams (mg), 1 tablet, 2 times daily. 2.The POC for the certification period 12/23/24 through 2/20/25, and the medication profile dated 12/31/24, failed to include Albuterol inhaler, Nitroglycerin, and Olodaterol/Tioptrop inhaler. 3. The POC and the medication profile included Trospium 20mg, 1 tablet, daily, and Wellbutrin XL (used to treat depression). 4. Wellbutrin XL was not included on the orders from the VA Nebraska-Western Iowa Health Care System, Home and Community Based Services, dated 10/23/24. 5. There was no documentation in the clinical record that the physician was notified of the medication discrepancies. G. Review of Patient 9’s clinical record revealed: 1.CHI Lakeside Hospital discharge summary, dated 6/13/24, included orders for CBD Caramels (used for anxiety), and Herblax (used for constipation). 2. The POC for the certification period 10/12/24 through 12/10/24 and 12/11/24 through 2/8/25, and the medication profile, dated 12/31/24, failed to include CBD Caramels and Herblax. 3. There was no documentation in the clinical record that the physician was notified of the medication discrepancies. H. Review of Patient 10’s clinical record revealed: 1.Discharge orders and information from Nebraska Medicine, dated 11/22/24, included orders for Acetaminophen (used for mild to moderate pain). 2. The POC for the certification period 11/17/24 through 1/15/25, and the medication profile, dated 12/31/24 failed to include Acetaminophen. I. Review of Patient 11’s clinical record revealed: 1.An Encounter Summary from CHI Health Lakeside, from the encounter date 11/19/24 through 11/23/24, included orders for Potassium Chloride (supplement), start taking 11/23/24 and stop taking 12/23/24. 2. The POC for the certification period 11/25/24 through 1/23/25, and the medication profile, dated 12/23/24, failed to include the end date of the Potassium Chloride. J. During an interview on 1/15/25 at 12:00 PM, the Administrator confirmed the agency failed to follow their policy and procedures to ensure the patient’s medication orders on the Plan of Care and the medication profile, were accurate for 8 of 17 patient records reviewed (Patient 1, 3, 5, 7, 8, 9, 10, 11).”

“Revisions communicated to patient and MDs CFR(s): 484.60(c)(3)(i) (i) Any revision to the plan of care due to a change in patient health status must be communicated to the patient, representative (if any), caregiver, and all physicians or allowed practitioner’s issuing orders for the HHA plan of care. This Element is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to ensure staff notified the patient’s physician when a change in wound status occurred for 1 of 10 patient records reviewed (Patient 5), who received wound care. The total sample size was 17. The census was 177. Findings are: A. Review of the agency’s policy and procedure titled Plan of Care/Care Planning Process, AA-014, reviewed 11/4/24, revealed: 1.Each patient was to have an individualized written plan of care, including any revisions or additions. 2. Revisions to the plan of care were to be communicated to the patient’s provider. 3. Modifications to the plan of care were to be documented in a verbal order obtained from the patient’s physician. B. Review of the agency’s policy and procedure titled Coordination of Care, TX-002, reviewed 5/22/24, revealed: 1.Any revisions to the plan of care, due to a change in the patient’s health status, were to be communicated to the patient’s physician. 2. The Clinical Manager was responsible for assuring the plan of care was updated. C. Review of the agency’s policy and procedure titled Assessment/Reassessment, AA-003, reviewed 10/10/24, revealed the patient’s physician was to be notified when the plan of care was to be altered. D. Review of Patient 5’s record revealed: 1.The Home Health Certification and Plan of Care (POC) for the certification period 11/28/24 through 1/26/25, included orders for Skilled Nurse (SN), to provide wound care daily and PRN (as needed) to the patient’s right lower distal leg: a . Cleanse with soap and water b. Apply Santyl (an ointment used to remove damaged tissue from a wound) to the wound. c. May apply skin barrier to the surrounding wound PRN to prevent maceration. d. Cover with a 4 X 4 gauze, and secure with Kerlix (rolled gauze dressing). 2. Nurse to perform/teach patient/caregiver wound care to the right lower distal leg. 3. SN to perform/teach patient/caregiver wound care, daily and PRN for soiled dressing, to right elbow, included orders to: a. Cleanse with soap and water b. Apply Mepilex (foam absorbent dressing). c. May apply skin barrier to peri wound (skin surrounding the wound), PRN to prevent maceration. 4. A Client Coordination Note Report, dated 12/5/24, revealed the right elbow wound and the right lower distal leg wound were healed and completely epithelialized. 5. There was no documentation in the clinical record the physician was notified that the right elbow and the right lower distal leg wounds were healed, or that the plan of care for these wounds needed to be revised. E. During at interview on 1/15/25 at 12:00 PM, the Administrator confirmed the agency failed to follow their policy and procedure of notifying the physician with a change in the patient’s condition, which required a POC revision.”