Every finding on record at North Arkansas Regional Medical Center

On 06/17/24 at 12:00 p.m., 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 the compliance with the Conditions of Participation for Home Health. On 06/20/24 at 10:30 a.m., an exit conference was conducted with Agency Representatives. Preliminary findings were discussed.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on pre-survey review of the Agency's reports, it was determined the agency failed to transmit all comprehensive assessments within the 30 day timeframe as required by CMS Conditions of Participation (CoP). This failed practice, if not corrected, could result in more late records submissions. A review of the HHA (Home Health Agency) Error Summary report showed there were 9 comprehensive records that had been submitted over 30 days after the completion of the assessment record as of 06/11/2024.

On 4/12/2022 at 1130 AM 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 the compliance with the Conditions of Participation for Home Health. On 4/15/2022 at 10:00 AM an exit conference was conducted with Agency Representatives. Preliminary findings were discussed. On 4/18/2022 additional information was requested from Agency Representatives.

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 notify the physician of patient taking an FDA banned medication and/or a prescription which is over ten years old and failed to complete a medication interaction check for all medications in 1 (#9) of 14 (#1-#14) clinical records reviewed. This failed practice by the SN posed a risk of potential harm for all patients prescribed medication by inhibiting the Nurse and Physician's ability to make informed decisions regarding the patient's medication regiment related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. 1. Review of Patient # 9 Clinical Record revealed the following: A. A document titled "Home Health Care Certification and Plan of Care" certification dates 3/2/2022 through 4/30/2022 contained orders for the medication propoxyphene 100/650 mg. B. A document titled, "Medication Profile" (A current, most up to date list of all medications a patient is taking) shows Propoxyphene 100/650 mg tablet; take 1/2-1 tabs orally every 4-6 hours as needed for pain with a start date of 3/2/2022. C. Interview with Agency Representative #1 verified patient #9 is taking Propoxyphene. D. A document from FDA.gov states propoxyphene was discontinued from U.S. market in November 2010, and has been banned due to serious cardiac side effects it caused. E. An interview with Agency Representative #1 confirmed the Agency did not notify the physician the patient is taking a banned medication. F. No evidence Propoxyphene was checked for interactions against all medications patient was currently taking.

Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on Clinical Record review and staff interviews, it was determined the Agency failed to provide the patient with pertinent verbal or written instructions regarding all medications in 1 (#9) of 14 (#1-#14) clinical records reviewed. This deficient practice has the potential to affect all patients on census receiving medications in that patients and families may be unaware of potential side effects, adverse reactions or medication complications that may occur. A. A review of document titled "NARMC Home Care" (North Arkansas Regional Medical Center Visit Note) the SN (Skilled Nurse) documented "Teaching provided on all high-risk medications including Xarelto, morphine and ASA., showing no evidence of Propoxyphene teaching. An interview conducted 4/15/22 at 10:30 AM, Agency Staff #1 agreed there was no teaching about Propoxyphene.