Every finding on record at Amedisys Arkansas, LLC

On 10/21/2024 at 11:20 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 for Home Health Agencies. On 10/24/2024 at 10:00 AM, an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed.

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 interview, it was determined the Agency failed to assure Oxygen (O2) was included in a review for all other Patient medications 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: Clinical Record #1 revealed: A) Document titled "Home Health Certification And Plan of Care" with dates of 08/09/24-10/07/24 listed a diagnosis of "Dependence on supplemental Oxygen." B) A report titled "Client Medication Report" listed Oxygen, 2lnc (2 liters by nasal cannula), when viewed on the agency EMR (electronic medical record), the O2 is highlighted in the color blue. At the bottom of the computer screen, it states "Meds (medications) displayed with a blue background will not be tested for drug interactions." Clinical Record #7 revealed: A) Document titled "Home Health Certification And Plan of Care" with dates of 08/26/24-10/24/24 listed a diagnosis of "Dependence on supplemental Oxygen." B) A report titled "Client Medication Report" listed Oxygen 2 liters PRN (as needed) for SOB (shortness of breath). When viewed on the agency EMR (electronic medical record), the O2 is highlighted in the color blue. At the bottom of the computer screen, it states "Meds (medications) displayed with a blue background will not be tested for drug interactions." Clinical Record #14 revealed: A) Document titled "Home Health Certification And Plan of Care" with dates of 09/14/2024-11/12/2024 listed a diagnosis of "Dependence on supplemental Oxygen." B) A report titled "Client Medication Report" listed Oxygen 2 liters PRN (as needed) for SOB (shortness of breath). When viewed on the agency EMR (electronic medical record), the O2 is highlighted in the color blue. At the bottom of the computer screen, it states "Meds (medications) displayed with a blue background will not be tested for drug interactions." On 10/23/2024 1:30 PM, Agency Representatives were asked if there was any documentation the oxygen had been checked against all other drugs. Agency Representative #1, "No." We haven't checked another way.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on Clinical Record Review and staff interview, it was determined the Agency Staff failed to ensure all patients (#1-#17) had an individualized plan of care that identified the patient-specific measurable outcomes and goals which were established, periodically reviewed, and signed by the patients physician or practitioner, This had the potential to affect all patients on census in that a clinician should have the ability to measure and document any pain the patient may have had prior to treatment, during the delivery of care and treatment, after treatment or as an unusual symptom. Without the ability to measure and reassess or remeasure the patients pain, there is no way a physician or practitioner can make an informed decision to intervene with changes to Plan of Care. It was determined during review, that all records (#1-#17) lacked pain parameters. Skilled Nurse was asking about pain on each visit & documenting it in the patients EMR (Electronic Medical Record). There was no pain parameter set for any patient, even those with a potential for needing a focused pain assessment and intervention for pain secondary to wounds or treatments. On 10/23/2024 at 12:40 PM, Agency Representatives were asked about the lack of pain parameters and Staff #1 stated," No, there are no parameters for pain. We need to do some teaching."

On 1/18/22 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 the Conditions of Participation for Home Health. On 1/21/22 at 9:30 AM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. .

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 (#10) of 1 (#10) 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. 1. Review of clinical record # 10 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC) dated 12/5/22 - 2/2/22 which listed a diagnosis of "Dependence on supplemental oxygen." B. Document titled "Client Medication Report" listed the medication Amiodarone (a medication used for Patients with Heart conditions). C. According to Drugs.com (a website used to check drug to drug interactions), using amiodarone and oxygen can increase the risk of adult respiratory distress syndrome (ARDS). ARDS can cause severe shortness of breath, rapid breathing and low oxygen. D. The Medication Profile showed no evidence the Oxygen mentioned in the POC was listed and assessed for potential adverse effects, drug reactions, significant side effects or significant drug interactions including the increased risk of ARDS. 2. During an interview on 1/21/22 at 9:00 AM, Agency Representatives were provided an opportunity to present additional documentation. Agency Personnel #1 confirmed the Agency staff did not include all medications the patients were currently using during a review of medications. Agency Personnel #1 stated "Oxygen was not on the medications list during the survey [1/18/22 - 1/21/22]"

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on Clinical Record review and Agency staff interviews, the Agency staff failed to ensure the patients Plan of Care (POC) included the required elements of all Patient specific interventions, education, measurable outcomes and goals identified by the Home Health Agency and the Patient in 3 (#10, #16, and #17) of 17 (#1 - #17) records reviewed. 1. Review of Clinical Record #10 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC) dated 12/5/21 - 2/2/22 which showed a pertinent diagnosis of "long term (current) use of opiate analgesic". B. Document titled "Client Medication Report" which listed Morphine ER (a drug prescribed for severe pain). C. Documents titled "Visit Note Report" dated 12/6/21, 12/15/21, 12/20/21, 1/4/22, 1/9/22, and 1/19/22 showed documentation by the Skilled Nurse (SN) assessments of pain on a scale of 1 - 10 with 10 being the worst pain. Pain was reported by the Patient at 8 or above for the "intensity of pain within the last 24 hours" on all visit note reports mentioned above. D.. There was no evidence of specific interventions, education, measurable outcomes and goals on the POC for Pain. 2. Review of Clinical Record #16 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC) dated 11/1/21 - 12/30/21 showed a pertinent diagnosis of "Other Chronic Pain." B. Document titled "Client Medication Report" which listed Fentanyl and Morphine (drugs prescribed for severe pain). C. Document titled "Visit Note Report" dated 11/1/21, showed documentation by the Physical Therapist of assessments of pain on a scale of 1 - 10 with 10 being the worst pain. The Patient reported Pain of 8 "within the last 24 hours" of this visit. D. There was no evidence of specific interventions, education, measurable outcomes and goals on the POC for Pain. 3. Review of Clinical Record #17 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC) dated 12/25/21 - 2/22/22 showed a pertinent diagnosis of "Hypertensive Heart Disease with Heart Failure." B. There was no evidence of specific individualized interventions, education, measurable outcomes and goals on the POC for Heart Failure. 4. During an interview on 1/21/22 at 9:00 AM, Agency Representatives were provided an opportunity to present additional documentation. Agency Personnel #1 confirmed the Agency staff did not include all specific individualized interventions, education, measurable outcomes and goals on the POC for Patient's #10, #16, and #17.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: . Based on Clinical Record review and staff interview, it was determined the Skilled Nurse (SN) failed to follow the Physician orders for patient specific interventions for urinary catheter insertion as ordered in the Plan of Care in 1 (#2) of 4 (#1, #2, #3 and #11) of 4 (#1, #2, #3, and #11) Clinical Records reviewed. This deficient practice had the potential to prevent the Physician and SN from evaluating the patients improvement or decline and prevented the Physician from determining the needed care. 1. Review of Clinical Record #2 revealed the following: A. Document titled " Certification and Plan of Care (POC)" dated 11/1/21 - 12/30/21 contained orders for "Skilled Nurse (SN) to perform insertion of 16 FR 10 cc Balloon indwelling catheter (size of urinary catheter)." B.. Document titled "Visit Note Report" dated 11/10/21 and 12/9/21, showed the SN documented insertion of 14 FR 10 cc urinary catheter. 2. During an interview on 1/21/22 at 9:30 AM, Agency Representatives were provided an opportunity to present additional documentation. Agency Personnel #1 confirmed the SN staff failure to follow the Physician orders for size of catheter insertion.