Every finding on record at Piggott Community Hospital

. On 8/28/23 at 12:15 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 8/31/23 at 9:30 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 all medications during the review of the patients medications in 2 (#3 and #7) of 10 (#1 - #10) Clinical Records reviewed. This failed practice by the SN posed a risk of potential harm for all patients on census 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. A review of Clinical Record #3 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC) dated 8/14/23 to 10/12/23 showed a pertinent diagnosis of "Dependence on supplemental oxygen." B. Document titled " Medication Profile" showed no evidence the Oxygen (O2) was listed and no evidence the Skilled Nurse (SN) included O2 during the review of the medications prescribed for Patient #3. C. During an interview on 8/31/23 at 9:20 A.M., Agency Staff member #1 verified the O2 was not included on the medication profile and therefore failed to be included in the medication review for Patient #3. 2. A review of Clinical Record #7 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC)" dated 8/19/23 to 10/17/23 showed a pertinent diagnosis of "Cannabis use, unspecified, uncomplicated." The POC contained documentation of "Patient has Oxygen concentrator in the home..." B. Document titled " Medication Profile" showed no evidence the Cannibus and O2 were listed and no evidence the Skilled Nurse (SN) included Cannabis and O2 during the review of the medications prescribed for Patient #7. C. During an interview on 8/31/23 at 9/20 A.M., Agency Staff member #1 verfified that Cannibus and O2 were not listed on the Medication Profile and therefore were not included in the review of all medications for Patient #7.

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 Clinical Record review and staff interview, it was determined the Agency staff did not follow the Attending Physician orders contained in the Plan of Care (POC) for 1 (#6) of 10 (#1 - #10) Clinical Records reviewed. This failed practice if not corrected had the potential of increased risk of rehospitalizations due to uncontrolled pain. A review of Clinical Record #6 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC)" dated 7/16/23 to 9/13/23 contained orders for "SN (Skilled Nurse) to assess vital signs during each skilled nursing visit and notify MD (Medical Doctor) of any vital signs outside normal parameters." The POC showed the SN was to report "Pain greater than 4." B. Review of Skilled Nursing notes showed Patient #6 reported pain at 5 on 7/25/23, 6 on 8/8/23, and 5 on 8/22/23 during the SN visits for those dates. There was no evidence the SN reported the pain outside of ordered pain parameters to the MD for these SN visit dates as ordered on the POC. C. During an interview on 8/31/23 at 9:20 A.M., Agency staff member #1 verified the SN failed to report to the MD pain outside the ordered parameters for 7/25/23, 8/8/23, and 8/22/23 for Patient #6.

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 Home Visits, Agency Policy and Procedures, and Agency Staff interview, it was determined the Skilled Nurse (SN) did not follow standards of practice for Infection Prevention in 2 (#1 and #2) of 4 (#1 - #4) home visits completed. This deficient practice if not corrected could result in potential patient infections and potential for hospitalizations and exacerbations of disease processes. During a home visit with Patient #1 on 8/29/23 at 1:30 P.M., the surveyor observed Skilled Nurse (SN) providing care for a PICC (Peripherally Inserted Central Catheter that is threaded through a larger vein (usually close to the bend of arm) and extends internally from the arm to the heart and is used to provide antibiotic infusions.) A. During the PICC dressing change, the surveyor observed the SN failed to offer the Patient a mask or any education to turn patient's head away from PICC site as SN removed the soiled dressing and during the sterile technique of replacing the soiled dressing with a clean dressing. The surveyor observed Patient # 1 securing the distal end of the PICC line using an un-sanitized and non-gloved finger. B. Review of Agency Policy/Procedures for PICC dressing changes shows: "Perform hand hygiene, Don Clean gloves, remove soiled dressing, discard, Perform hand hygiene, Open sterile kit, don mask and sterile gloves, remove securement device while securing the PICC line with one hand." Patient #1, secured the PICC with ungloved/non-sanitized finger, instead of the SN securing the PICC with one hand as instructed by Agency Policy/Procedure. 2. During a home visit with Patient #2 on 8/30/23 at 2:30 P.M., the Surveyor observed Skilled Nurse (SN) providing care for a PICC. A. During the PICC dressing change, the Surveyor observed the SN failing to re-sanitize hands between glove changes, entering the clean and dirty side of SN visit bag without donning gloves and sanitizing hands. 3. During an interview on 8/31/23 at 3:00 P.M., Agency staff member #1 and #3 verified proper infection prevention was not followed by the SN for Patient #1 and #2,