Every finding on record at Five Rivers Medical Center, Inc.

. On 10/24/22 at 1:30 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 10/27/22 at 10:20 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 4 (#5, #6, #7, and #8) of 10 (#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. Review of Clinical Record #5 revealed the following: A. Document titled "Certification and Plan of Care (POC)" dated 8/26/22 to 10/24/22 which contained the following order for the Skilled Nurse, "SN to assess, perform, instruct "Oxygen (02) at 2 - 3 L/NC (2 to 3 Liters/Nasal Canula) PRN (as needed) for SOB (shortness of breath)." B. Document titled "Medication Profile," (document used by the Agency to record medication being used by Patients), showed "Oxygen 2-3 L/NC inhaled PRN SOB (Shortness of Breath)." 2. Review of Clinical Record #6 revealed the following: A. Document titled "Certification and Plan of Care (POC)" dated 9/26/22 to 11/24/22 contained a diagnosis of "Dependence on supplemental oxygen." B. Document titled " Medication Profile" listed "Oxygen 2-3 LPM (Liters per min)". 3. Review of Clinical Record #7 revealed the following: A. Document titled "Certification and Plan of Care (POC)" dated 10/8/22 to 12/6/22 contained a diagnosis of "Oxygen use." B. Document titled " Medication Profile" showed no evidence 02 was listed as a medication for Patient #7. 4. Review of Clinical Record #8 revealed the following: A. Document titled "Certification and Plan of Care dated 7/8/22 to 9/5/22 contained a diagnosis of "Dependence on supplemental oxygen." B. Document titled " Medication Profile" listed "Oxygen 3-4 Liters/minute inhaled per nasal cannula PRN SOB." 5. There was no evidence that 02 was included in the medications review for Patients #5, #6, #7, and #8. 6. During an interview on 10/27/22 at 9:30 AM, Agency Representatives were provided an opportunity to present additional documentation. With no additional documentation presented, Agency Personnel #1 confirmed the Agency staff did not include all medications for Patients #5, #6, #7, and #8 were reviewed. Agency Personnel #1 confirmed, "Oxygen was not included on the medications profile for Patient #7." Agency Personnel #1 reported the electronic medical record system the Agency used did not include 02 in the review of medications for potential adverse effects, drug reactions, significant side effects or significant drug interactions.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation during home visits, staff interviews, review of Agency Policy and Procedures, and review of Center for Disease Control (CDC) guidelines, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 2 (#2 and #3) of 4 (#1 through #4) home visits conducted. This deficient practice had the potential to place all patients on census and staff at risk for infection, cross-contamination, and hospitalization. The Center for Disease Control publication "Morbidity and Mortality Weekly Report" dated October 25, 2002/ Vol. 51/ N. RR-16 "Guide for Hand Hygiene in Health-Care Settings" viewed at https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf on 11/2/2022 defined the indications for hand washing and hand antisepsis including after removing gloves and prior to donning another pair of gloves.. Review of Agency Policy No. 35 dated 8/3/21 for Bag Technique/Hand Hygiene states: "Wash/sanitize hands between glove changes during procedures. A. Observation during a home visit with Patient #2 on 10/26/22 at 8:45 A.M. the Surveyor observed the SN providing wound care. The SN changed gloves during the procedure more than once and failed to perform hand hygiene/antisepsis after removal of soiled gloves and prior to donning new gloves. 3. Review of Agency Policy No. 54 dated 8/7/20 and revised 8/4/21 titled "Infection Prevention and Control" states "The Agency will ensure proper cleaning/disinfecting of all patient care items used with multiple patients." A. During a home visit with Patient #3 on 10/26/22 at 9:45 A.M., the Surveyor observed the Skilled Nurse (SN) providing wound care for Patient #3. The SN used wound scissors to remove the Patient's soiled dressings and then failed to sanitize the wound scissors after removal of the soiled dressing. The SN then used the same wound scissors to cut the clean dressings used to cover the wound. 4. During an interview with agency staff on 10/27/22 at 9:30 A.M., staff member #1 verified that the Skilled Nurse observed failed to follow standard precautions for infection control and the Agency's policies regarding hand hygiene and cleaning of equipment during patient procedures.