Every finding on record at Ahm Action Home Health, LP

On 10/07/2024 at 10:45 AM, an entrance conference was conducted with Agency Representatives.. The Agency was informed the purpose of the visit was to conduct a Medicare recertification survey for compliance with 42 CFR Part 484 Conditions of Participation of Home Health Agencies. On 10/10/2024 at 10:30 AM, an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on clinical record review and interview, it was determined the Agency failed to ensure the Physician's order was followed in 1 (#13) of 13 (#1-#13) clinical records reviewed. This failed practice had the potential to affect all patients on census with foley catheters. Findings follow: A. Clinical record #13 revealed a document titled Home Health Certification And Plan of Care with a Physicians order of "Skilled Nurse for insertion of indwelling foley catheter using catheter 16 French (the diameter size of the catheter tube), 30 ml balloon inflated with 30 ml of normal saline. (this is the size of the balloon inflated after the catheter is inserted into the bladder).Skilled nurse to change Q (every) monthly and 1-3 visits PRN (as needed) for dislodgement, leakage or occlusion. B. A Document titled "Visit Note Report" with a date of 09/30/2024, shows narrative documentation by SN (Skilled Nurse), "...New catheter was inserted.16FR (French) foley catheter inserted with a bulb (Balloon) of 10cc. C. Agency Staff were given an opportunity to provide additional information. None was provided.

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 record review and staff interview, it was determined the Agency failed to ensure there was a documented complete review of the medication side effects and possible drug interactions for 1 (#10) of 13 client records reviewed. (#1-#13). This failed practice had the potential to negatively impact all patients as there was a potential for adverse reactions or interactions without a comprehensive review completed. Findings follow: A. Document titled "Home Health Certification And Plan of Care" with certification dates of 07/18/2024 through 11/15/2024 shows a diagnosis of "Dependance On Supplemental Oxygen." B. Review of the document titled "Client Medication Report" printed 10/07/2024. When this report is viewed on a computer screen via the EMR (Electronic Medical Record) instead of a printed paper copy, the medication Oxygen is highlighted in blue. At the bottom of the screen, the program explains "medications highlighted in blue are not checked for interactions." C. Staff member #1 was asked if there was any documentation showing the oxygen had been checked for interactions. Staff #1 stated, "No."

On 2/15/22 at 12:00 PM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 2/17/22 at 8:30 AM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. On 2/22/22 additional information was requested from Agency. .

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 Clinical Record review and staff interviews, it was determined the Skilled Nurse (SN) failed to include Oxygen (O2) during the review of the patients medications in 1 (#2) of 13 (#1- #13) Clinical Records reviewed. This failed practice by the SN posed a risk of potential harm for patients on census receiving O2 therapy by inhibiting the Nurse and Physician's ability to make informed decisions regarding the patients medication regimen related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. A review of documentation revealed the following: 1) A document titled Home Health Certificate and Plan of Care dated 12/18/21 to 2/15/22 listed DME (Durable Medical Equipment) revealed "Oxygen Supplies." 2) A document titled Client Medication Report, revealed "Oxygen 2 liters continuous." a) The electronic record revealed Oxygen highlighted in the color blue, indicating a medication that is not checked for interactions with all other listed medications. b) Agency Representative #1 confirmed Oxygen was not checked for interactions via the computer program used to check all other medications. c) Agency Representative #1 confirmed there is no evidence to indicate the Oxygen was checked for medication interactions using any other means.