Every finding on record at Hancock County

A complaint survey for complaint #61242 was completed at Hancock County Home Health Agency on 12/1/2021 to 12/3/2021. Deficiencies were cited related to the complaint under CFR Part 484, Requirements for Home Care Organizations Providing Home Health Care.

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 policy review, medical review and interviews, the agency failed to follow physician's orders for 1 patient (#1) of 3 patients reviewed. The findings included: Medical chart review revealed Patient #1 was admitted to the agency on 1/18/2021 with the diagnosis of Fistula of Intestine. Medical record review of the Home Health Certification and Plan of Care dated 9/15/2021 to 11/13/2021 revealed a physician's order to report any pain greater than 4 (scale 0-10). Further review revealed a physician's order to report any signs or symptoms of wound infection. Medical record review of nurse's notes dated 9/23/2021 to 10/4/2021 revealed the patient complained of a pain level of 2. The patient denied any pain during wound care. Further review revealed the fistula (wound) was located on the patient's abdomen which had drainage of "fecal matter". Medical record review of a nurse's note dated 10/4/2021 revealed the patient complained of a pain level of 8. Continued review revealed the pain level was also a 8 during wound care. Further review revealed the fistula was draining "fecal matter" and bile. The patient stated the drainage "worsens" when ambulating. No documentation noted the physician was notified of the changes of the wound or increased pain by the agency. Interview with the co-administrator confirmed the agency failed to follow the plan of care to notify the physician of the changes of the wound (fistula) and patient's increased pain.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on policy review, medical record review and interview, the agency failed to alert the physician of increased pain and changes in the wound for 1 patient (#1) of 3 patients reviewed. The findings included: Review of wound care policy (not dated) revealed the nurse was to report to the physician any signs/symptoms of wound infection. Review of pain management policy (not dated) revealed the nurse was to report pain level of 4 or greater (scale 0-10) to the physician. Medical record review revealed Patient #1 was admitted to the agency on 1/18/2021 with the diagnosis of Fistula of Intestine. Medical record review of nurse's notes dated 9/23/2021 to 10/4/2021 revealed the patient complained of a pain level of 2. The patient denied any pain during wound care. Further review revealed the fistula was located on the patient's abdomen which had drainage of "fecal matter". Medical record review of a nurse's note dated 10/11/2021 revealed the patient complained of a pain level of 8. The patient complained of pain level of 8 with the wound care. The patient complained of "burning from the bile drainage". Further review revealed the fistula was draining "fecal matter" and bile. The patient stated to the nurse the drainage "worsens" with ambulation. No documentation the agency alerted the physician of changes of the wound and increased pain.. Interview with the co-administrator on 12/2/2021 at 3:30 PM confirmed the agency failed to alert the physician of the wound changes or increased pain.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on medical record review and interview, the skilled nurse failed to follow the physician's orders for 1 patient (#1) of 3 patients reviewed. The findings included: Medical chart reviewed revealed Patient #1 was admitted to the agency on 1/18/2021 with the diagnosis of Fistula of Intestine. Medical record review of the Home Health Certification and Plan of Care dated 9/15/2021 to 11/13/2021 revealed a physician's order to report any pain greater than 4 (scale 0-10). Further review revealed a physician's order to report any signs or symptoms of wound infection. Medical record review of nurse's notes dated 9/23/2021 to 10/4/2021 revealed the patient complained of a pain level of 2. The patient denied any pain during wound care. Further review revealed the fistula (wound) was located on the patient's abdomen which had drainage of "fecal matter". Medical record review of a nurse's note dated 10/4/2021 revealed the patient complained of a pain level of 8. Continued review revealed the pain level was also a 8 during wound care. Further review revealed the fistula was draining "fecal matter" and bile. The patient stated the drainage "worsens" when ambulating. No documentation noted the physician was notified of the changes of the wound by the agency or the increased pain as ordered by the physician. Interview with the co-administrator confirmed the skilled nurse failed to follow the physician's orders to notify the physician of the changes in the wound (fistula) and patient's increased pain.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on medical record review and interview, the skilled nurse failed to communicate with the physician changes in pain and wound for 1 patient (#1) of 3 patients reviewed. The findings included: Medical record review revealed Patient #1 was admitted to the agency on 1/18/2021 with the diagnosis of Fistula of Intestine. Medical record review of nurse's notes dated 9/23/2021 to 10/4/2021 revealed the patient complained of a pain level of 2. The patient denied any pain during wound care. Further review revealed the fistula was located on the patient's abdomen which had drainage of "fecal matter". Medical record review of the Home Health Certification and Plan of Care dated 9/15/2021 to 11/13/2021 revealed the physician ordered skilled nursing services at 1 time a week. Further review revealed the skilled nurse was to communicate with the physician a pain level of 4 or greater (scale 0-10) and any signs or symptoms of wound infection. Medical record review of a nurse's note dated 10/11/2021 revealed the patient complained of a pain level of 8. The patient complained of pain level of 8 with the wound care. The patient complained of "burning from the bile drainage". Further review revealed the fistula was draining "fecal matter" and bile. The patient stated to the nurse the drainage "worsens" with ambulation. No documentation the the skilled nurse communicated the elevated temperature or wound care changes. Interview with the co-administrator on 12/2/2021 at 3:30 PM confirmed the skilled nurse failed to communicate the patient's increased temperature and wound care changes.