Medi Home Health & Hospice

“Based on record review, interviews, and review of the agency policy, the hospice agency failed to ensure that two of 14 patients (Patient (P) 2 and P3) had their medications reconciled from either the Skilled Nursing Facility (SNF) and/or Assisted Living Facility (ALF) to match the medications that the hospice agency ordered. This deficient practice had the potential to affect the accuracy of medications ordered for the patients. Findings include: Review of the agency policy titled, “Medication Management,” revised 09/2024,” indicated, “. . . Medications that are dispensed and used by the patient are monitored by hospice . . . The patient’s medications are reviewed and assessed during every comprehensive visit. When new medication is added or changes are made to an existing medication, the medication profile is updated in the medial record at a minimum at these time points . . .”1. Review of the agency provided “Plan of Care Order” indicated that P2 was admitted to hospice on 08/07/23 with a diagnosis of Myasthenia gravis. Review of P2’s agency provided, “Medication Profile,” dated 05/28/25-07/26/25, indicated orders for haloperidol (medication for agitation) oral tablet [0].5 milligrams (mg), give one tablet by mouth (PO) every four hours when needed (PRN) for agitation, starting 09/08/23. There was no documented evidence P2 was to receive acetaminophen and/or bisacodyl. Review of P2’s ALF facility provided “Transfer/Discharge Report,” dated 06/12/25, indicated orders for haloperidol lactate concentrate two mg/milligrams (ml), give one ml PO or under tongue every four hours PRN for hallucinations, starting 03/24/25. Continued review indicated that P2 was last administered haloperidol on 05/24/25. Further review indicated orders for bisacodyl 10 mg suppository (medication for constipation), insert one suppository rectally daily PRN for constipation, starting 03/24/25 and acetaminophen (medication for pain) 650 mg, insert one suppository rectally every four hours PRN for mild pain or fever, starting 04/01/25. Review of P2’s agency provided “Patient Medication Record,” dated 06/09/25, indicated that Registered Nurse (RN) 1 completed a medication review and found no discrepancies. During an interview on 06/12/25 at 9:50 AM, RN1 confirmed that he/she does a weekly medication review either with the nurse and/or medication tech where he/she goes over the medications on the computer. RN1 said that he/she liked to do these usually in the early part of the week. He/She confirmed that his/her last medication review was 06/09/25 and no discrepancies were found. During an interview on 06/12/25 at 4:00 PM, the Clinical Manager confirmed that the nurses were to complete a weekly medication review, which was usually completed towards the beginning of the week. The Clinical Manager confirmed that these medication orders were not written by their physician, and he/she was unaware that the ALF facility physician was writing orders for this patient, stating that should never have happened. He/She stated that he/she was going to call and get these clarified. 2. Review of the agency provided “Plan of Care Order” indicated that P3 was admitted to hospice on 01/17/25 with a diagnosis of senile degeneration of the brain.Review of P3’s agency provided, “Medication Profile,” dated 04/17/25-07/15/25, indicated orders for, albuterol sulfate hydrofluoroalkane (HFA) inhalation aerosol solution (medication for shortness of breath) 90 micrograms (mcg)/actuation (act), inhale one to two puffs every four hours when needed (PRN), starting 02/13/25; haloperidol (medication for agitation) one mg every four hours PRN, starting 01/17/25; and acetaminophen (medication for pain) 500 mg, one tablet three times daily PRN, starting 01/17/25. There is no documented evidence for order to apply skin prep to bilateral heels every shift and/or hydrochlorothiazide. Review of P3’s SNF facility provided “Physician Order Report,” dated 05/12/25-06/12/25, indicated orders for acetaminophen (medication for pain) 500 mg, three times a day (TID), starting 05/19/25 and discontinued 05/21/25; albuterol sulfate HFA inhalation aerosol inhaler (medication for shortness of breath) 90 mg/act, two puffs every four hours for shortness of breath/wheezing; hydrochlorothiazide (medication for high blood pressure) 25 mg once a day; and apply skin prep to bilateral heel every shift, starting 05/30/25. There was no documented evidence of haldol. Review of P3’s agency provided “Patient Medication Record,” dated 06/10/25, indicated that RN2 completed a medication review and found no discrepancies. During an interview on 06/12/25 at 4:00 PM, the Clinical Manager confirmed that the nurses were to complete a weekly medication review, which was usually completed towards the beginning of the week. The Clinical Manager confirmed that these medication orders were not written by their physician, and he/she was unaware that the SNF facility physician was writing orders for this patient, stating that should never have happened. He/She stated that he/she was going to call and get these clarified.During an interview on 06/12/25 at 4:18 PM, the Clinical Manager confirmed that the physician orders did not match and indicated that hydrochlorothiazide was discontinued on 04/24/25 when another medication was ordered. He/She stated he/she was going to have to call and send these orders again to ensure the SNF got them and carried them out. He/She stated he/she was unaware that these orders were not being carried out.”

“Based on observation, interviews, record review, and policy review, the agency failed to provide personal care in a manner to prevent cross contamination for one of two patients (Patient (P) 3) observed during home visits out of a total sample of 14. This had the potential to increase the risk of infection for the patients. Findings include:Review of agency policy titled, “Infection Control Program,” revised 10/2024, indicated, “. . . Hospice staff follows accepted standards of practice to prevent transmission of infections and communicable diseases, including the use of standard precautions in the care of all hospice patients, which includes, but is not limited to: a. Use of gloves when providing services to all infectious patients and when there is potential to come in contact with blood, body fluids, secretions, excretions (except sweat), non-intact skin and mucous membranes . . .”Review of the agency provided “Plan of Care Order” indicated that P3 wasadmitted to hospice on 01/17/25 with a diagnosis of senile degeneration of the brain.During a home visit on 06/12/25 at 10:50 AM, Certified Nursing Assistant (CNA)1 was observed completing a shower for P3. CNA1 gathered supplies, took P3 to the shower room, and put on gloves. CNA1 assisted P3 to stand and hold onto the handrail, as CNA1 removed P3’s clothing and soiled brief that was observed to be soiled with a bowel movement (BM). Without changing his/her gloves, CNA1 sat P3 on the shower chair and grabbed the handheld shower faucet, turned on the water and started washing P3. Towards the end of the shower, P3 had another BM. CNA1 grabbed some paper towels and wiped P3 but did not change his/her gloves until afterwards and continued to finish washing and rinsing P3. After rinsing P3, CNA1 turned off the water and placed a towel over P3. CNA1 changed his/her gloves. CNA1 dried P3, placed clothing on P3 and placed P3 back into his/her wheelchair. Then CNA1 removed P3 from the shower room and returned to the shower room to clean up.During an interview on 06/12/25 at 11:45 AM, CNA1 indicated that gloves should have been changed when going from a dirty area to a clean area. CNA1 confirmed that she has had infection control training. During an interview on 06/12/25 at 2:00 PM, the Clinical Manager (CM) indicated that gloves should be changed when going from a dirty area to a clean area.”