Interim Healthcare of Cedar Bluff

“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 document review and interview, the Home Health Agency (HHA) failed to (1) complete a thorough review of all the medications the patient was taking to identify any potential drug interactions or duplicate drug therapy (2) develop policies that guided staff if a concern was identified that should be report to the primary care provider (PCP) for four of seven patients (Patient (P) 11, P15, P16, and P17) reviewed for medication interactions of 17 sample patients. This failure had the potential to result in adverse medication effects and/or drug interactions. Findings include: Review of the policies provided during the survey revealed the documentation failed to address the procedure for utilizing the “Medication Review” and “Interactions” capabilities present in the electronic medical record (EMR) to identify potential drug interactions or duplicate drug therapy or the process for notifying the PCP. The Administrator confirmed there were no other policies or procedures that identified this process. 1. Review of P11’s current “Medication Profile” provided by the agency revealed ordered medications included: meloxicam (anti-inflammatory medication) oral tablet 15 milligrams (mg) once a day, aspirin oral tablet chewable 81 mg once a day, trazodone HCl [hydrogen chloride] (used for sleep and depression) oral tablet 50 mg, citalopram hydrobromide (a selective serotonin reuptake inhibitor used for treatment of depression) oral tablet 20 mg daily, hydrocodone-acetaminophen 5-325 mg (short acting narcotic pain medication) oral tablet as needed every 6 hours, and oxycodone-acetaminophen (short acting narcotic pain medication) oral tablet as needed every 4 hours. Review of P11’s “Medication Review” located in the EMR in the “Clinical” tab under “Medication Profile,” revealed “No” was checked by the admitting nurse for “Are any drug interactions identified among the patient’s medications” and “Does the patient have any duplicate medications?” Review of the “Interactions” tab in the EMR identified the following potential Drug-Drug interactions with a severity of “Major” related to the current patient’s medications: a. Non-selective nonsteroidal anti-inflammatory agents [NSAID] (Meloxicam) may diminish the cardioprotective effect of aspirin. Meloxicam may enhance the adverse/toxic effect of aspirin. An increased risk of bleeding may be associated with use of this combination. Aspirin may decrease the serum concentration of Meloxicam. b. Additive effects may occur during coadministration of citalopram hydrobromide and Trazodone HCl mg, and the risk of developing serotonin syndrome (symptoms include agitation, muscle twitching, spasms, rapid heart rate, high blood pressure, and sweating) may be increased. c. Toxic effects may be increased with concurrent administration of Meloxicam Oral Tablet 15 MG and Citalopram Hydrobromide oral tablet 20 mg. The risk of upper gastrointestinal bleeding may be increased. Patients taking both drugs concurrently should be educated about the signs and symptoms of gastrointestinal bleeding. Review of the “Interactions” tab in EMR identified the following potential duplicate drug therapies related to the patient’s current medications: a. Use of oxycodone-acetaminophen oral tablet 5-325 mg and hydrocodone-acetaminophen oral tablet 5-325 mg may represent a duplication in therapy based on their association to the therapeutic drug class acetaminophen. b. Use of oxycodone-acetaminophen oral tablet 5-325 mg and hydrocodone-acetaminophen oral tablet 5-325 mg may represent a duplication in therapy based on their association to the therapeutic drug class short-acting opioid analgesics. Review of the medical record did not indicate that information was relayed to P11’s PCP about potential drug interactions or duplicate drug therapy. 2. Review of current “Medication Profile” provided by the agency revealed ordered medications included: buspirone HCl (anti-anxiety medication) oral tablet 7.5 mg twice a day, Lexapro (used to treat anxiety and depression) oral tablet 20 mg daily, Review of P15’s “Medication Review” located in the EMR in the “Clinical” tab under “Medication Profile” revealed “No” was checked by the Administrator for “Are any drug interactions identified among the patient’s medications?” Review of the “Interactions” tab in the EMR identified the following potential Drug-Drug interactions with a severity of “Major” related to the current patient’s medications revealed the following: a. Additive serotonergic effects may occur during coadministration of buspirone, and Lexapro and the risk of developing serotonin syndrome may be increased. Review of the medical record did not indicate that information was relayed to P15’s PCP about potential drug interactions or duplicate drug therapy. 3. Review of P16’s current “Medication Profile” provided by the agency revealed ordered medications included: buspirone HCl 30 mg twice a day via gastrostomy tube (g-tube - a thin, flexible tube inserted through the abdominal wall and into the stomach) and desvenlafaxine (used to treat depression) ER (extended release) 50 mg via g-tube. Review of P16’s “Medication Review” located in the EMR in the “Clinical” tab under “Medication Profile” revealed “No” was checked by the Registered Nurse on admission and at recertification for “Are any drug interactions identified among the patient’s medications?” Review of the “Interactions” tab in the EMR identified a total of 30 potential drug to drug interactions with a severity rating of “Moderate” related to P16’s current medication list. One drug to drug potential interaction had a severity rating of “major” identified as “Additive serotonergic effects may occur during coadministration of buspirone and desvenlafaxine may be increased.” Review of the medical record did not indicate that information was relayed to P15’s PCP about potential drug interactions or duplicate drug therapy. 4. Review of P17’s current “Medication Profile” provided by the agency revealed ordered medications included: albuterol sulfate inhaler as needed every 6 hours for shortness of breath/asthma, Coreg (used to treat heart failure and high blood pressure) 12.5 mg twice daily, fluticasone furoate-vilanterol inhaler (for asthma) once a day, amlodipine besylate (for high blood pressure) 5 mg once a day, valsartan (for high blood pressure) 160 mg twice a day, and Lasix (diuretic) 20 mg as needed daily. Review of P17’s “Medication Review” located in the electronic medical record (EMR) in the “Clinical” tab under “Medication Profile” revealed “No” was checked by the Administrator on admission and recertification for “Are any drug interactions identified among the patient’s medications” and “Does the patient have any duplicate medications?” Review of the “Interactions” tab in the EMR identified the following potential Drug-Drug interactions with a severity of “Major” related to the current patient’s medications: a. Pharmacologic effects of albuterol sulfate inhalation may be decreased by Coreg oral tablet. Untoward physiologic effects, characterized by bronchospasm may occur. The two medications have opposite effects on the body and can counteract each other. b. Pharmacologic effects of Fluticasone Furoate-vilanterol inhaler may be decreased by Coreg oral tablet. Untoward physiologic effects, characterized by bronchospasm may occur. The two medications have opposite effects on the body and can counteract each other. Review of the “Interactions” tab in EMR identified the following potential duplicate drug therapies related to the patient’s current medications: a. Use of Albuterol sulfate inhaler and Fluticasone furoate-vilanterol inhaler may represent a duplication in therapy based on their association to the therapeutic drug class beta-adrenergic agents. b. Use of Coreg oral tablet, amlodipine besylate oral tablet, Valsartan oral tablet, and Lasix oral tablet may represent a duplication in therapy based on their association to the therapeutic drug class anti-hypertensives. During an interview on 10/02/25 at 1:30 PM, the Administrator confirmed that the questions on the “Medication Review” were answered as “No” despite the “Interactions” tab identifying potential drug interactions and duplicate drug therapy. The Administrator confirmed the agency does not have a process for communicating these findings to the patient’s PCP.”

“Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on document review, interview, observations, and policy review, the Home Health Agency (HHA) failed to provide the patient with a written schedule of medication for seven of seven patients (Patient (P) 11, P12, P13, P14, P15, P16, and P17) reviewed during home visit observations of 17 sample patients. This failure had the potential to result in medication errors, drug interactions, or side effects. Findings include: Review of the agency’s policy titled, “Coordination of Care/Services,” dated 04/02/21, revealed, “The designated Clinical Manager ensures the patient/client/caregiver is provided with written instructions outlining: … Patient medication schedule/instructions, including: medication name, dosage and frequency.” 1. Review of P11’s Plan of Care (POC) located in the electronic medical record (EMR) in the “Clinical” tab revealed a Start of Care (SOC) date of 08/28/25. During a home visit observation on 09/30/25 at 12:00 PM, P11 denied receiving written medication instructions from the HHA. 2. Review of P12’s POC located in the EMR in the “Clinical” tab revealed a SOC date of 05/02/25. During a home visit observation on 09/30/25 at 1:15 PM, Family Member (F) 1 denied receiving written medication instructions from the HHA and stated, “We have a list of medications from the doctor’s office.” Review of P12’s medications in the home with F1 compared to the “Medication Profile” provided by agency prior to the home visit revealed the following discrepancies: a. P12 was currently taking Metoprolol (used to treat high blood pressure) 25 milligrams (mg) one tablet in the AM and one-half tablet in the PM. The HHA “Medication Profile” only showed Metoprolol 25 mg one tablet in the AM. b. The HHA “Medication Profile” showed P11 was taking Potassium Chloride (used to treat low blood levels of potassium) ER (extended release) 20 mEq (milliequivalent). F1 stated Potassium Chloride was discontinued. c. The HHA “Medication Profile” showed P11 was taking Sulfamethoxazole-Trimethoprim (an antibiotic) oral tablet 800-160 mg (milligrams) twice daily. F1 stated this was discontinued. d. F1 identified that P11 took Lutein (an over the counter (OTC) antioxidant which can slow the progression of age-related macular degeneration) once daily, which was not on the “Medication Profile.” 3. Review of P13’s POC located in the EMR in the “Clinical” tab revealed a SOC date of 01/08/25. During a home visit observation on 09/30/25, F2 denied receiving written medication instructions from the HHA. Review of P13’s medications in the home compared to the “Medication Profile” provided by the agency prior to the home visit revealed P13 was also taking Zofran four (4) mg up to three times a day as needed for nausea. 4. Review of P14’s POC located in the EMR in the “Clinical” tab revealed a SOC date of 09/19/25. Diagnosis included “attention to gastrostomy” and “malignant neoplasm of lower third of esophagus.” During a home visit observation on 09/30/25 at 4:30 PM, F3 confirmed they had not received a written medication list from the HHA. Observation during the home visit revealed Zofran four (4) mg three times a day as needed for nausea and a bottle of Pepto Bismol (heartburn/indigestion) sitting on the bedside table. Review P14’s “Medication Profile” provided by the agency prior to the home visit did not include either of these medications. F3 confirmed that P14 used these medications as needed. During the home visit, F3 stated he/she had given P14 one-half of a Dulcolax suppository, two generic stool softeners, Milk of Magnesia, and one-half of a bottle of magnesium citrate yesterday due to constipation lasting approximately 10 days. F3 stated he/she had consulted with daughter who was a nurse about what to do. None of these OTC medications were included on the agency’s medication profile that had been provided prior to the home visit observation. The medication profile did not include any medications for constipation. 5. Review of P15’s POC located in the EMR in the “Clinical” tab revealed a SOC date of 01/31/25. During a home visit observation on 10/01/25 at 8:30 AM, P15 denied having received written medication instructions from the HHA. Review of P15’s medications in the home compared to the “Medication Profile” provided by the agency prior to the home visit revealed P15 was also taking Fluconazole (used to treat yeast infection) 150 mg tablet once a day and melatonin (to help with sleep) 1.5 mg daily. 6. Review of P16’s POC located in the EMR in the “Clinical” tab revealed a SOC date of 07/31/25. During a home visit observation on 10/01/25 at 9:30 AM, P16 denied having received written medication instructions from the HHA. In addition to the medications listed on the “Medication Profile” provided by the agency prior to the home visit, P16 identified he/she took a generic stool softener daily in addition to Senokot (an OTC laxative) as needed. Neither of these OTC medications were on the “Medication Profile.” 7. Review of P17’s POC located in the EMR in the “Clinical” tab revealed a SOC date of 03/06/25. During a home visit observation on 10/01/25 at 10:30 AM, P17 denied having received written medication instructions from the HHA. During the home visit observation, the Physical Therapy Assistant provided a copy of the HHA POC for the current certification period of 09/02/25 to 10/31/25. In addition to the medications listed on the “Medication Profile” provided by the agency prior to the home visit, P17 identified he/she took loratadine 10 mg as needed for allergies, Tylenol as needed for pain, vitamin C tablet daily, vitamin D3 1250 micrograms (mcg) daily, a multivitamin with folic acid daily, and an iron tablet daily. None of these OTC medications were listed on the “Medication Profile.” During an interview on 10/01/25 at 12:30 PM, the Administrator stated, “We give the patient their plan of care which includes a list of medications, but we don’t give a specific document with written medication instructions.” The Administrator confirmed the medications identified on the POC should include all medications the patient was taking including OTC medications. The Administrator stated, “The medications should be reviewed at least every sixty days if the patient is recertified for services.” The Administrator did not know if staff reviewed the medications or updated the medications on the POC at any point during the sixty-day certification period.”