Every finding on record at Middlesex Hospital

Unannounced visits were concluded at Middlesex Hospital Homecare on 2/15/2022 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

Unannounced visits concluded at Middlesex Hospital Home Care on 2/15/2022 for the purpose of recertification and re-licensure. Standard level deficiencies were identified.

Transmittal of OASIS data CFR(s): 484.45(c) Standard: Transmittal of OASIS data. An HHA must- This STANDARD is not met as evidenced by: Based on a review of clinical records, interview with agency personnel, and policy review, for one of seventeen Patients (Patient #13) in the survey sample, the agency failed to complete and submit the discharge OASIS (Outcome and Assessment Information Set) in accordance with the applicable federal government regulation. The finding includes: Patient #13 had a start of care date of 11/05/2021 with diagnosis that included lumbar fracture, falls and type II diabetes mellitus. The physician’s orders for the certification period of 11/05/2021 through 01/03/2022 included nursing services one time per week for three weeks followed by one time every other week for three weeks for assessments, medication management and home safety teaching. Additionally, social work, physical and occupational therapy evaluations were ordered. Review of Patient #13’s clinical record and interview with the Administrator on 02/15/2022 at 12:45 PM, identified Patient #13 was discharged from the agency on 12/30/2021 due to the Patient’s inability to meet goals and safely manage his/her care but failed to identify that a discharge OASIS was completed. The Administrator indicated the agency expected the discharge OASIS would be completed and submitted within 48 hours. Review of the agency’s policy for Discharge Planning, identified premature discharge was defined as termination of service(s) when goals of care have not been met and review of the agency’s policy for Nursing Service identified the primary care nurse is responsible and accountable for regular evaluation of patient progress, and termination of care.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on review of the clinical record, agency policy and interview with agency personnel, for one of one patient (Patient # 5) who required measurements of tubing to ensure that Peripherally Inserted Central Catheter (PICC) did not migrate, the agency registered nurses/RN failed to conduct the necessary assessments. The finding includes: Patient# 5 had a start of care date of 1/21/22 and diagnoses that included urinary tract infection with bacteremia, autonomic dysreflexia and quadriplegia. The physician's order dated 1/21/22 included skilled nursing services once a week for assessments and midline dressing changes. The initial nursing assessment dated 1/21/2022 identified the presence a left cephalic midline catheter for infusion of antibiotics. The Memorandum of Understanding (MOU) developed between the Home Health Agency and the Infusion Company on 1/20/22 identified the responsibilities of both the home health agency and the Infusion Company in patient assessment, communicating changes in the patient condition, medical orders and intravenous medical supplies and equipment. Interview and review of RN #1’s nursing note dated 1/21/22 with the Administrator on 2/15/22 at 10 am identified the measurement of the PICC catheter length of 8.0 centimeters/cm and an arm circumference measurement of 27 cm but failed to identify subsequent documented measurements on 1/26/22, 2/04/22 and 2/09/22 of the arm circumference above the insertion site, and measurements of the external tubing in accordance with agency expectations and policies. Agency policy on PICC infusion therapy directed in part to confirm length of PICC line external catheter.

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 a review of clinical records, interview with agency personnel, and policy review for one of seventeen Patients (Patient #17) in the survey sample, the agency failed to follow the physician-certified plan of care. The finding includes: Patient #17 had a start of care date of 01/09/2022 with diagnosis that included COVID pneumonia, acute respiratory failure, and dependence on supplemental oxygen. The physician’s orders for the certification period of 01/09/2022 through 03/09/2022 included nursing services one time per week for three weeks for assessments and home oxygen safety teaching. Additionally, a telemonitor device (a device installed in the Patient’s home to electronically monitor and transmit vital signs to the agency for evaluation) was ordered for daily monitoring of the Patient’s vital signs and an Occupational therapy evaluation for energy conservation teaching. Review of Patient #17’s clinical record and interview with the Administrator on 02/15/2022 at 12:30 PM, identified Patient #17 declined the installation of the telemonitor device on 01/17/2022. Furthermore, the Administrator failed to identify the Patient’s physician was notified of Patient #17’s refusal of the telemonitor device which was ordered on the initial plan of care dated 01/09/2022. Review of the agency’s policy for Nursing Services indicated the primary care nurse is responsible and accountable for coordination of services with the patient, family and others involved in the care plan and review of the agency’s policy for Home Telemonitoring indicated the telemonitoring system implemented would be an integral part of the quality care provided to Patients and required a physician’s order at the time of admission and incorporated into the admission plan of care.