Butte Home Health Hospice

“Based on observation, interview, and record review, the agency failed to provided one out of 19 sampled patients (Patient 17) care coordination (ongoing sharing of information between all care providers involved with the patients care) when: Home Health Aide (HHA) 6 did not document or share ongoing hair hygiene (condition and appearance of hair) concerns with Patient 17s Registered Nurse Case Manager (RN) 1. RN 1 did not request a current medication list from the skilled nursing facility in which Patient 17 resided. This failure had the potential for needed services to be missed, and for the agency to not be aware of any medication changes that were made by the skilled nursing facility. Findings: During a review, of the agencys policy and procedure titled, “;Continuity and Coordination of Care,” revised 11/4/20, it indicated that there would be ongoing sharing of information, that related to patient care, between agency staff and skilled nursing facility staff. During a review, of the agencys policy titled, “;Coordination of Services-Hospice Aide,” revised 11/4/20, it indicated that the Home Health Aide (HHA) was required to report patient changes. 1. Patient 17’s medical record was reviewed. Patient 17s “;Hospice Plan of Care” (POC, a document that described what care was provided to the patient), indicated that Patient 17 was admitted to the agency on 2/27/23, with the diagnoses of heart failure (the heart was not able to properly pump blood through the body), and systolic congestive heart failure (the heart was weak, and the bottom of the heart did not work correctly). The POC indicated, that Patient 17 required assistance for all activities of daily living (brushing hair, washing hair, dressing, bathing, toileting, and changing positions). The POC indicated, that Patient 17 lived at skilled nursing facility. During a concurrent observation, and interview, on 5/8/24 at 9 am, located within Patient 17s skilled nursing facility room, Home Health Aide (HHA) 6 was observed providing a bed bath and hair hygiene. When HHA 6 assisted Patient 17 onto her left side, Patient 17s hair, on the back of her head, was observed to be severely matted (multiple tangles that were packed so tightly it formed a thick, packed, mass of hair that could not be brushed). The area of matted hair covered more than 75 percent of the back of Patient 17s head and was approximately 1 inch thick in the middle of the matted hair mass. HHA 6 confirmed that Patient 17s hair was severely matted and stated, that Patient 17s hair had been matted, off and on for some time, but never to this extent. HHA 6 was observed trying to brush Patient 17s hair, and then stated that Patient 17s hair was so, “;bad, I cant brush it.” During an interview, on 5/8/24 at 11:53 am, Registered Nurse (RN) 1 confirmed, there had been on and off again issues with Patient 17s hair being matted. RN 1 stated, that the agency staff would verbally care coordinate with the inpatient facility staff, regarding concerns with Patient 17s hair, and the inpatient facility would correct the hair hygiene concerns. RN 1 stated, not being notified by the agencys HHAs that Patient 17s hair was matted, and the last time RN 1 had been made aware of Patient 17 matted hair, was “;in the Fall” (more than 5 months ago). During a concurrent interview, and record review, on 5/8/24 at 3:33 pm, HHA “;Visit Notes,” dated 4/23/24 through 5/8/24 were reviewed with Director of Patient Care Services (DPCS). DCPS confirmed, there was no documentation present that indicated Patient 17s hair had been matted, until the HHA visit on 5/8/24. DCPS confirmed, there had been an on again, off again issue with Patient 17s hair becoming matted and was not made aware of the severity of Patient 17s hair, and should have. During an interview, on 5/8/24 at 4:46 pm, HHA 6 stated, care coordination, regarding Patient 17s matted hair, took place between HHA 6 and RN 1 verbally, and was unable to recall when RN 1 was made aware of Patient 17s matted hair. HHA 6 confirmed, that the HHA “;Visit Note,” dated 5/8/24, was the first time HHA 6 had documented that Patient 17s hair was severely matted. 2. During a concurrent interview, and record review, on 5/8/24 at 3:33 pm, with DCPS, Patient 17s “;Medication List,” (developed by the agencys RN) dated 2/24/23 through 3/27/24, was reviewed. DCPS confirmed, the “;Medication List,” indicated that on 2/24/23, the physician ordered lorazepam (a medication used to treat anxiety, also known as Ativan) 0.5 milligrams (mg, unit of measure), one tablet, every four hours as needed for anxiety, agitation, or shortness of breath. DCPS reviewed the facility’s “;Medication Administration Record” (MAR), dated 5/1/24 through 5/31/24 and confirmed, that the MAR indicated, on 5/7/24, the inpatient facilitys physician, changed Patient 17s lorazepam order from every four hours as needed to every six hours as needed. DCPS confirmed the “;Medication List,” indicated on 2/27/23, the physician ordered acetaminophen EQ (a medication used to treat fevers, aches, and pain, also known as Tylenol) 325 mg, two tablets, twice daily. DCPS reviewed the facility’s “;Medication Administration Record” (MAR), dated 5/1/24 through 5/31/24. DCPS confirmed the MAR indicated the facilitys physician changed Patient 17s lorazepam order from every four hours as needed to every six hours as needed and confirmed acetaminophen EQ 325 mg, two tablets, twice daily was not located on the MAR. DCPS stated when the agency RNs visited patients at an inpatient facility, the RNs should request a copy of the MAR and compare the MAR to the agencys “;Medication List.” DCPS stated both the “;Medication List,” and the MAR should have the same medication orders and confirmed, that there was a lack of care coordination between the agency’s RN and the facility’s nurses regarding Patient 17s current medication list.”