Every finding on record at Amedisys Hh, A Lawrence Medical Center Partner, LLC

Based on a recertification survey conducted on 10/4/22 to 10/6/22, Amedisys Home Health Agency a Lawrence Medical Center Partner was found to be in substantial compliance with the requirements for Emergency Preparedness regulations.

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 review of medical records (MR), policy and procedure, observations, and interviews, it was determined staff failed to maintain an accurate medication profile for each patient. This affected five of seven home visits (HV) conducted, including HV # 2, HV # 4, HV # 3, HV # 5, HV # 7, and had the potential to affect all patients served by the agency. Findings include: Agency Policy: Drug Regimen Review Policy number: MA-002 Date revised: 01/2020 Purpose: To identify appropriateness, inconsistencies, and/or significant drug interactions in the patient's current medication regimen, as well as ensure the comprehensive list of medications are updated any time there is a medication change including dose changes, new medications, and any medications discontinued. Procedure: 1. The clinician completing the OASIS (Outcome and Assessment Information Set) must complete a comprehensive drug regimen review of all medication the patient is currently taking at the time of admission, recertification, resumption of care and with any major change in condition. The medication profile is completed by documenting: All the patient medications which includes: ... Over the counter medications, Herbal products, Vitamins and Supplements... If any problems/ concerns are noted, the RN (Registered Nurse)- Clinical Manager... must contact the Physician to verify... and amend the medication profile as indicated... 5. HV # 7 was admitted to the agency on 9/30/22 with diagnosis of Permanent Atrial Fibrillation. A HV was conducted 10/4/22 at 3:19 PM to observe care provided by EI # 4, Physical Therapist. During the HV, a comparison was made between medications observed in the home and the CMR provided to the surveyor on 10/4/22 by the agency. The following medications were on the CMR and the patient stated, he/she had stopped taking them on 8/9/22: a) Doxycycline Hyclate 100 mg capsule, take one capsule twice daily. b) Ergocalciferol (Vitamin D2) 1,250 mcg (microgram) (50,000 units) capsule, take one capsule weekly. c) Magnesium 400 mg tablet, take one tablet daily. d) Vitamin B-12 1,000 mcg tablet, take one tablet daily. e) Zinc 50 mg tablet, take one tablet daily. f) Famotidine 20 mg tablet, take one tablet daily. The patient stated, he/she has not taken famotidine for several years. An interview conducted on 10/6/22 at 11:50 AM with EI # 1 confirmed the staff failed to maintain an accurate CMR. 3. HV # 3 was admitted to the agency on 6/9/22 with diagnoses including Parkinson's Disease and Essential (Primary) Hypertension. A HV was conducted on 10/4/22 at 11:30 AM to observe care provided by EI # 7, Certified Occupational Therapy Assistant. During the HV, the medications observed in the home were compared to the CMR printed on 10/4/22 at 9:25 AM. The following discrepancies were observed: a) Quetiapine 50 mg tab, one tab twice a day was listed on the CMR. The bottle in the home read Quetiapine 100 mg tab, one tab twice daily. The date filled on the bottle was 9/22/22, and confirmed by the caregiver. The caregiver stated that the patient takes 50 mg in the morning and 100 mg at night. b) Over The Counter (OTC) Rolaids Extra Strength chewable tablets (675 mg Calcium Carbonate and 135 mg Magnesium Hydroxide) was in the home and not listed on the CMR. The caregiver stated that the patient seldom takes it but he took 2 tabs yesterday. The directions on the bottle stated "chew 2-4 tablets as symptoms occur" and also advised "do not take more than 10 tablets in a 24-hour period." c) Simvastatin 40 mg, 1 tablet daily at bedtime was in the home and not listed on the CMR. The caregiver stated that the patient takes it as prescribed. Date filled on the bottle was 7/28/22, and confirmed by the caregiver. d) Zofran ODT (Ondansetron) 4 mg, 1 tablet three times daily as needed was in the home and not listed on the CMR. The caregiver stated that the patient rarely needs the med and has been taking it once a week or less. Date filled on the bottle was 6/7/22, and confirmed by the caregiver. e) Over The Counter Zyrtec 10 mg daily was in the home and not listed on the CMR but the caregiver confirmed that the patient has been taking it daily for at least two or three years. An interview was conducted on 10/6/22 at 11:40 AM with EI # 1, who confirmed the staff failed to maintain an accurate CMR. 4. HV # 5 was admitted to the agency on 10/3/22 with diagnoses including Chronic Systolic (Congestive) Heart Failure. A HV was conducted on 10/4/22 at 1:00 PM to observe care provided by EI # 5, Medical Social Worker. During the HV, the medications observed in the home were compared to the CMR printed on 10/4/22 at 10:19 AM. The following discrepancy was observed: a) Cozaar 50 mg, one tablet daily, and Losartan 50 mg, one tablet daily were both listed on the CMR and are the same medication. The patient had Losartan 50mg in the home. The date filled on the bottle was 9/8/22, and confirmed by the caregiver. An interview was conducted on 10/6/22 at 11:25 AM with EI # 1, who confirmed the staff failed to update the CMR. 1. HV # 2 was admitted to the agency on 7/22/22 with diagnoses including Essential (Primary) Hypertension, and Displaced Subtrochanteric Fracture Right Femur, Subsequent Encounter for Closed Fracture with Routine Healing. A HV was conducted on 10/4/22 at 12:00 PM to observe care provided by Employee Identifier (EI) # 2, Physical Therapy Assistant. During the HV, the medications observed in the home were compared to the Client Medication Report (CMR) printed on 10/4/22 at 9:35 AM. The following discrepancies were observed: a) Alprazolam 1 mg (milligram) tablet (tab), one tab daily was listed on the CMR. The bottle in the home read one tab three times daily, as needed. The date filled on the bottle was 9/6/22, and confirmed by the caregiver. b) Quetiapine 25 mg tab, one tab daily was listed on the CMR. The bottle in the home read Quetiapine 50 mg tab, one tab twice daily. The date filled on the bottle was 9/16/22, and confirmed by the caregiver. An interview was conducted on 10/6/22 at 11:30 AM with EI # 1, Director of Operations, who confirmed staff failed maintain an accurate CMR. 2. HV # 4 was admitted to the agency on 7/20/22 with diagnoses including Essential (Primary) Hypertension, and Partial Intestinal Obstruction, Unspecified as to Cause, and recertified for care from 9/18/22 to 11/16/22. A HV was conducted on 10/4/22 at 1:00 PM to observe care provided by EI # 3, Licensed Practical Nurse. During the HV, the medications observed in the home were compared to the CMR printed on 10/4/22 at 9:46 AM. The following discrepancies were observed: a) Benazepril 20 mg - Hydrochlorothiazide (HCTZ) 12.5 mg, one tablet daily, was listed on the CMR. Benazepril 10 mg, one tablet daily, was in the home. The date filled on the prefilled daily packet was 9/2/22, and confirmed by the caregiver. b) HCTZ 12.5 mg, one tablet daily, was in the home, and not listed separately on the CMR. The date filled on the prefilled daily packet was 9/2/22, and confirmed by the caregiver. c) Flomax 0.4 mg, one tablet at bedtime, was in the home and not on the CMR. The date filled on the bottle was 9/13/22, and confirmed by the caregiver. An interview was conducted on 10/6/22 at 11:42 AM with EI # 1, who confirmed staff failed to update the CMR.