Every finding on record at Harmony Home Health Care, Inc

Complaint Survey LA00055243 Census - 98 Abbreviations: IV - Intravenous DON - Director of Nursing LPN - Licensed Practical Nurse SN - Skilled Nurse UA - urinalysis C&S - culture and sensitivity cg - caregiver SNV - Skilled Nurse Visit

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to coordinate care delivery to meet the patient's needs for 1 (#2) of 5 sampled patients, as evidenced by the agency failing to ensure the skilled nurse followed up with the patient/cg after receiving orders for IV fluids. Findings: Review of patient #2's Home Health Certification and Plan of Care for certification period 3/27/2020 to 5/25/2020 revealed the patient was admitted on 3/27/2020 with diagnoses that included Secondary Malignant Neoplasm of the Bone, Left Adrenal Gland, and Liver and Intrahepatic Bile Duct, Non-infective Gastroenteritis and Colitis and History of other Malignant Neoplasm of the Kidney. Review of the SNV note dated 5/19/2020 at 12:34 p.m. revealed patient was sitting in recliner upon entrance, blood pressure was low and temperature was low. Caregiver reported the patient had been vomiting since 5/18/2020 and not drinking any water. Caregiver reported the patient had a fever of 101 degrees during the night. Review of a Client Coordination Note Report dated 5/19/2020 revealed labs for UA and C&S were obtained. Review of a Client Coordination Note Report documented by S2 LPN dated 5/20/2020 revealed a significant event/problem of B/P 92/58, pulse - 81, respiration - 18, temperature - 95.2. Patient reports vomiting since yesterday, last vomiting episode was this morning 10:30 a.m. The patient's cg reported the patient was not staying hydrated. Left message with nurse at the patient's physician office. Review of a Client Coordination Note Report documented by S2 LPN dated 5/20/2020 at 9:43 a.m. revealed orders were received for IV fluids D5 Normal Saline 2 liters over 20 hours from the physician's nurse. The physician's nurse had ordered supplies from the Pharmacy. Stated IV to be started on date of 5/21/2020 if supplies are not delivered by 5:00 p.m. This nurse attempted to call pharmacy but was already closed when nurse called, nurse would contact the pharmacy in the morning to verify delivery of supplies and how the IV would be administered (IV ball, dial flow or pump). SN informed wife that home health would be out in the morning to administer IV fluids related to patient not having supplies at this time. Pharmacy to deliver supplies sometime tonight. Continued review of the Client Coordination Note Report dated 5/20/2020 at 9:43 a.m. revealed the wife called very upset stating that the supplies were delivered last night and a nurse should have come last night to administer medications. S2 LPN informed the caregiver that a nurse would be coming this morning to administer medication around 10:00 a.m. and 11:00 a.m. today. Caregiver still upset stating that we only want to come at the convenience of the nurses and not the patient. S2 LPN instructed the caregiver that the agency had orders to administer medication today related to the patient didn't have the supplies when we closed and when the SN had tried to call the pharmacy to see when the supplies would be delivered but they were already closed. SN tried to explain to the caregiver that the home health agency would be coming today and had received all the information from the pharmacy that was needed before we can send a nurse today. Interview with S2 LPN on 01/21/2021 at 12:15 p.m. revealed the first part of the Client Coordination Note Report dated 5/20/2020 was documented after it had occurred and she had incorrectly documented the wrong dates of when the IV was to be started. She revealed the date should have been documented as 5/20/2020. S2 LPN revealed on 5/19/2020 the physician's office called at the end of the work day with orders for IV fluids to be administered. S2 LPN stated she tried calling the pharmacy but they had already closed for the day. S2 LPN stated she was unable to know when the IV supplies would have been delivered. S2 LPN revealed she contacted the pharmacy the next morning and found out it had been delivered on the evening of 5/19/2020. S2 LPN revealed she contacted the physician 5/20/2020 and received orders to start it that morning (5/20/2020). Interview with S1 DON on 1/21/2021 at 12:30 p.m. revealed the staff should have coordinated with the family on 5/19/2020 on when the supplies were delivered from the pharmacy with the on call staff to go and start the IV fluids as ordered. She stated the family should have been told to call the on call nurse when the supplies had arrived and not wait to the next day to get the IV fluids started.