Nhc Homecare Murfreesboro

“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, observation and interview, the facility failed to ensure medications were accurately documented for 7 of 7 (Patient #1, 2, 3, 4, 5, 14 and 15) sampled patients observed during home visits. The findings included: 1. Review of the facility policy “Medication Review and Reconciliation” revised 5/22 revealed “…Purpose: To establish processes that maximize patient safety and outcomes related to medications and to comply with related state and federal regulations and best clinical practices. Policy: Medication review and reconciliation is completed as a part of all comprehensive assessments (at start of care, resumption of care, recertification and discharge) and with every medication change…Medication review and reconciliation is a multi-faceted and on-going process performed via interview and observation techniques…” 2. Medical record review for Patient #1 revealed a Start of Care (SOC) date 3/11/2025 with diagnoses including Osteoarthritis of the knee and a fractured femur. Observations in Patient #1’s home on 6/24/2025 at 12:30 PM, revealed the following medications in the home that were not documented on “Home Health Certification and Plan of Care” for the certification period from 5/10/2025 to 7/8/2025: Vitamin B-12 1000 micrograms (mcg) once daily and Vitamin D-3 1000 international units once daily. During an interview on 6/24/2025 at 12:50 PM, Patient #1 verified she was taking both Vitamin B-12 and Vitamin D-3. 3. Medical record review for Patient #2 revealed a SOC date of 6/20/2025 with diagnoses including Fracture Left Femur and Atrial Fibrillation. Review of the “Home Health Certification and Plan of Care” for the certification period from 6/20/2025-8/18/2025, revealed the following medication orders: Vitamin C (used to support the immune system) 500 milligrams (mg) 1 tablet daily Ferrous Sulfate (used to prevent and treat iron deficient anemia) 325 mg 1 tablet daily Omeprazole (used to treat gastroesophageal reflux disease) 40 mg 1 capsule daily Potassium Chloride Extended Release (used to treat low potassium) 10 milliequivalent (meq) 1 tablet daily Albuterol Sulfate Hydrofluoroalkane (HFA) (used to treat or prevent bronchospasms) 90 mcg/inhaler every four hours as needed Benzonatate (use to prevent cough) 200mg capsule three times daily as needed Ondansetron Hydrochloride (HCL) (used to prevent nausea and vomiting) 4 mg tablet every four hours as needed Observations in Patient #2’s home on 6/24/2025 at 11:30 AM, revealed the following medications were not in the patient’s home: Vitamin C 500 mg tablets, Ferrous Sulfate 325 mg tablets, Omeprazole 40 mg capsules, Potassium Chloride 10 meq. capsules, Albuterol Sulfate Inhaler HFA 90 mcg, Benzonatate 200 mg capsules and Ondansetron HCL 4mg tablets with Patient #2’s medications. During an interview on 6/24/2025 at 11:30 AM, Patient #2 stated she had been on Vitamin C 500 mg tablets, Ferrous Sulfate 325 mg tablets, Omeprazole 40 mg capsules, Potassium Chloride 10 meq capsules, Albuterol Sulfate Inhaler HFA 90 mcg, Benzonatate 200 mg capsules and Ondansetron HCL 4mg tablets while she was in the hospital. Patient #2 confirmed she has not taken them since she had been home. During an interview on 6/24/2025 at 11:45 AM, the Occupational Therapist stated that the Home Health Agency staff were supposed to review their medication list during each visit. 4. Medical record review for Patient #3 revealed a SOC date of 4/02/2025 with diagnoses including Spinal Stenosis and Multiple Myeloma. Review of the “Home Health Certification and Plan of Care” for the certification period from 4/2/2025-5/31/2025, revealed the following medication orders: Dexamethasone (used to treat inflammation) 6 mg tablet 2 tablets weekly Eliquis (used to prevent blood clots) 5mg tablet twice daily Furosemide (used to prevent swelling) 40 mg tablet daily Irbesartan (used to treat high blood pressure) 75 mg tablet daily Memantine (used for memory) 10 mg tablet twice daily Metoprolol Succinate Extended Release (ER) (used to treat high blood pressure) 50 mg tablet daily Potassium Chloride (ER) (used to treat low potassium) 20 meq tablet daily Acyclovir (used to treat shingles) 400 mg tablet twice daily Review of the Medication Administration Record from Assisted Care Living Facility (ACLF) #1 revealed the following medications were not on the POC: Albuterol HFA (used to treat bronchospasms) 90mcg every four hours as needed, Calcium (used to treat low calcium) 600 mg twice daily, Vitamin D 3 (used to treat low vitamin d) 125 mcg daily, Omeprazole (used to treat gastroesophageal disease) 20 mg daily, Oxycodone (used to treat severe pain) 5mg every six hours as needed, Robitussin (used to treat cough) 5ml every six hours as needed, Tizanidine (used to treat muscle spasms) 2 mg three times daily as needed, Trazodone (used to treat insomnia) 50 mg every night. During an interview on 6/24/2025 at 10:00 AM, the Physical Therapy Assistant stated that the Home Health Agency staff were supposed to review their medication list with the medication list from ACLF #1 during each visit. 5. Medical record review for Patient #4 revealed a SOC date of 2/18/2025 with diagnoses including Pressure Ulcer of Right Heel and Cellulitis of the Right Lower Limb. Review of the “Home Health Certification and Plan of Care” for the certification period from 6/18/2025-8/16/2025, revealed the following medication orders: Omeprazole 40 mg 1 capsule daily Bisoprolol fumarate (used to treat high blood pressure and other cardiovascular conditions) 5 mg 1 tablet daily Observations in Patient #4’s home on 6/24/2025 at 11:15 AM, revealed the following medications: Pantoprazole (used to treat heartburn and reduce the amount of acid in the stomach) 40 mg with an initial prescription date of 9/17/2024 1 capsule daily Bisoprolol/hydrochlorothiazide (HCTZ) (combination medication used to treat high blood pressure) 5 mg/6.25 mg with an initial prescription date of 1/17/2024 1 tablet daily Aspirin (anticoagulant) 81 mg over the counter (OTC) There were no omeprazole 40 mg capsules or bisoprolol fumarate 5 mg tablets with Patient #4’s medications. During an interview on 6/24/2025 at 11:25 AM, Patient #4 confirmed he took pantoprazole 40 mg 1 capsule daily and bisoprolol/HCTZ 5 mg/6.25 mg 1 tablet daily since the initial prescription date for each medication. Patient #4 confirmed he did not take omeprazole 40 mg or bisoprolol fumarate. When asked how long he had been taking aspirin 81 mg, Patient #4 stated he took 1 tablet each day for the past 10-15 years. 6. Medical record review for Patient #5 revealed a SOC date of 1/14/2025 with diagnoses including Heart Failure and Pressure Ulcer. Review of the “Home Health Certification and Plan of Care” for the certification period from 5/14/2025-7/12/2025, revealed the following medication orders: Metoprolol Succinate Extended Release (used to treat high blood pressure) 25 mg ½ tablet by mouth twice daily Observations in Patient #5’s home on 6/24/2025 at 12:40 PM, revealed the following medications: Metoprolol tartrate (non-extended-release medication used to treat high blood pressure) 25 mg ½ tablet twice daily, Potassium chloride (supplement used to treat low potassium levels) 10 meq 1 tablet daily. There were no metoprolol succinate 25 mg tablets with Patient #5’s medications. During an interview on 6/24/2025 at 12:40 PM, Patient #5 stated she had been on potassium chloride since sometime in January 2025. Patient #5 confirmed that she had been taking metoprolol tartrate which was in her medications rather than metoprolol succinate. 7. Medical record review for Patient #14 revealed a SOC date of 3/14/2025 with diagnoses including Chronic Obstructive Pulmonary Disease and Diabetes Mellitus. Review of the “Home Health Certification and Plan of Care” for the certification period from 5/13/2025-7/11/2025, revealed the following medication orders: Fentanyl Patch (used to treat severe pain) 37.5 mcg/hr every 72 hours Simethicone (used to relieve symptoms of gas) 125 mg 1 tablet daily Torsemide (used to treat edema and high blood pressure) 100 mg 1 tablet daily Review of the Medication Administration Record from ACLF #1 revealed the following medications: Fentanyl Patch 50 mcg/hr every 72 hours with an initial start date of 6/6/2025 Simethicone 125 mg 1 tablet twice daily with an initial start date of 9/5/2024 Torsemide 20 mg to be added to the torsemide 100 mg for a total of torsemide 120 mg daily with an initial start date of 6/11/2025 During an interview on 6/24/2025 at 9:50 AM, Licensed Practical Nurse #1 stated that the Home Health Agency #1 staff were supposed to review their medication list with the medication list from ACLF #1 during each visit. 8. Medical record review for Patient #15 revealed a SOC date of 4/29/2025 with diagnoses including Fracture Left Pubis and Atrial Fibrillation. Review of the “Home Health Certification and Plan of Care” for the certification period from 4/29/2025-6/27/2025, revealed the following medication orders: Cyanocobalamin (used to treat b12 deficiency) 1000 mcg sublingual daily Observations in Patient #15’s home on 6/24/2025 at 2:00 PM, revealed the following medications: Cyanocobalamin 3000 mcg sublingual daily, Centrum (used to treat or prevent vitamin deficiency) 1 tablet daily, and Hydrochlorothiazide (used to treat blood pressure) 25mg daily During an interview on 6/24/2025 at 2:00 PM, Patient #15 stated she was taking Cyanocobalamin 3000 mcg daily, Centrum tablet daily, and Hydrochlorothiazide 25mg daily. During an interview on 6/24/2025 at 2:15 PM, the Physical Therapist stated that the Home Health Agency staff were supposed to review their medication list during each visit. PT stated he would clarify the medication record with the physician. 9. During an interview on 6/25/2025 at 10:33 AM, the Administrator stated he expected the clinical staff to assess for any medication changes at each home visit and update the medication in the medical record.”