Every finding on record at Mohave Healthcare, Inc

Based on observation, interview, and record review, the agency failed to ensure patients medication profile were being reviewed for two of 14 sampled patients (Patients 2 and 3) when: 1. For Patient 2, the agency did not develop policies and procedures in obtaining informed consent (a voluntary consent of the patient to take psychotropic medication) for psychotropic medications (medications that affect behavior, mood, thoughts, or perception) use. Four out of five of Patient 2s psychotropic medications did not have informed consent form signed by the patient/responsible party. 2. For Patient 3, the agency did not ensure a medication reconciliation was conducted during nursing and supervisory visit for Patient 3. These failures had the potential to cause ineffective drug therapy, significant side effects and noncompliance with drug therapy, placing Patients 2 and 3s health at risk. --- 1. A review of Patient 2s ";Patient Information Report" (a document that gives a summary of patients information) and plan of care (a document that provides direction of type of nursing care a patient needs), indicated a start of care date of April 13, 2023, with a recertification period of July 12, 2023, to October 9, 2023. Further review indicated Patient 2 had a diagnosis of Alzheimers disease (a progressive disease that destroys memory and other important mental functions), anxiety (feelings of excessive, unrealistic worry and tension with little or no reason), insomnia (inability to sleep) and hypertension (elevated blood pressure). During a review of facility provided document titled, ";Client Medication Report," dated September 15, 2024, it indicated the following: i. Haloperidol (antipsychotic medication) 2 milligrams tablets, 1 tablet every 3 hours for agitation, start date May 18, 2023. ii. Lorazepam (antianxiety medication) 1 milligram tablet, 1 tablet every 3 hours for anxiety, start date September 12, 2023. iii. Risperidone (antipsychotic medication) 0.25 milligram tablet, 2 tablets, 2 times daily for agitation, start date June 28, 2023. iv. Temazepam (sedative hypnotic) 30 milligram capsules, 1 capsule at bedtime for insomnia, start date May 18, 2023. v. Trazodone (antidepressant) 50 milligram tablet, 4 tablets at bedtime for insomnia, start date June 28, 2023. During a home visit on September 13, 2023, at 12:49 PM, with a Registered Nurse (RN), RN inspected Patient 2s medication bottles, which were available in the home. The medication bottles were inside the kitchens cabinet. RN compared them with Patient 2s most current medicine list. During further observation and interview, on September 13, 2023, at 12:51 PM, with RN, RN found the following psychotropic medications: i. A sealed bottle containing Haloperidol (medication use to treat agitation) 2 milligrams (unit of measurement) tablets. ii. An opened bottle of Lorazepam (medication to treat anxiety) 1 milligram tablet. ii. An opened bottle of Risperidone (medication to treat agitation) 0.25 milligram tablet. iv. An opened bottle of Temazepam (medication to treat insomnia) 30 milligram capsules. v. An opened bottle of Trazodone (medication to treat insomnia) 50 milligram tablet. RN stated, psychotropic medications must have an informed consent. During a follow up interview and record review, on September 13, 2023, at 12:53 PM, with RN, RN reviewed Patient 2s ";Hospice Admissions Booklet (provided by the agency to keep at home)" and was not able to find informed consent for the psychotropic medications. RN stated, ";It must be in the patients records, at the office." During a concurrent record review and interview, with the Administrator (Admin), on September 14, 2023, at 2:25 PM, the Admin reviewed Patient 2s document titled, ";Informed Consent for Psychotropic Medications," dated April 13, 2023, which indicated ";... A physician or NP [Nurse Practitioner] has prescribed the following psychotropic medication(s):... Lorazepam." Admin stated, Patient 2's Haloperidol, Risperidone, Temazepam and Trazodone were not included in the informed consent. During further interview, with the Admin, on September 15, 2023, at 9:20 AM, the Admin stated, it was the nurses responsibility to obtain informed consent for all psychotropic medications, to assure families understand the mediations, side effects and potential for chemical restraint. Admin stated, it was part of the hospice admission booklet. Admin was not able to provide policies and procedures regarding obtaining informed consent for psychotropic medications. 2. A review of Patient 3s ";Patient Information Report" and plan of care, indicated a start of care date of September 9, 2023, with a recertification period of September 6, 2023, to December 4, 2023. Further review indicated Patient 3 had diagnoses of severe protein-calorie malnutrition (when patient has muscle wasting, loss of subcutaneous fat, bedridden or significantly reduced functional capacity), heart failure (when heart does not pump blood as well as it should), bed confinement (bedridden), urinary incontinence (loss of bladder control). During a home visit on September 13, 2023, at 1:28 PM, with a Licensed Practical Nurse (LPN), LPN inspected Patient 3s medication bottles, which were available in the home. The medication bottles were on top of the kitchens table. LPN compared them with Patient 3s most current medicine list. During a concurrent observation and interview, on September 13, 2023, at 1:36 PM, with LPN, LPN found a small bag, which contained Bisacodyl (medication use to treat constipation) 10 milligrams (unit of measurement) suppository. LPN counted the contents of the bag and stated there were six suppositories in the bag. LPN reviewed Patient 3s ";Medicine list," dated September 13, 2023, and stated Bisacodyl suppositories medications were not included in Patient 3s medicine list. LPN stated nurses should reconcile the medicine profile with the medications on hand every home visit. During concurrent interview and record review of Patient 3s current medicine list, on September 14, 2023, at 3:05 PM, the Director of Patient Care Services (DCPS) acknowledged Patient 3s current medicine list did not include Bisacodyl 10 milligrams. The DPCS stated medications should be reconciled by nurses every home visit and update the medicine list. During a concurrent record review and interview, with the DCPS, on September 14, 2023, at 3:12 PM, the DCPS reviewed the agencys undated policy and procedure (P&P) titled ";Medication Reconciliation", which indicated ";... Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication." The DPCS stated the agency did not follow the policy.

Based on interview and record review, the agency failed to maintain an effective infection control program when the surveillance data (system of collecting patient records and data to measure changes, and trends) and risk analysis (is an interpretive process that draws conclusions from a set of facts) were not routinely reviewed and monitored to prevent and control infections in a universe of 10 patients. This failure had the potential to cause the spread of the infection to the agencys patients. Findings: A review of the agencys ";Infection Control" electronic record, for the year 2023, was conducted. It contained data collection. There was no documented evidence to show surveillance data and risk analysis had been initiated from the data collected. There was no documented evidence to show that the agency had developed a system to identify the root cause, patterns, or trends in the agencys infection control program from January 1, 2023, through August 31, 2023. During an interview on September 14, 2023, at 2:20 PM with the Administrator (Admin) and the Quality Officer Nurse (QON), the QON stated she was responsible for the Infection Control Program. The QON stated the surveillance and analysis had not been done from the data collected reports from January 1, 2023, to August 31, 2023, because she had been unaware of the requirement. During a concurrent interview and record review, on September 14, 2023, at 3:15 PM, with the Admin and QON, the agencys policy and procedure (P&P) titled, ";Infection Control Plan," revised July 2021, was reviewed. The P&P indicated, ";... PURPOSE. To prevent or decrease the exposure of patients and employees to diseases and infections and to establish and maintain a surveillance program of identifying, reporting, and analyzing infections. PROCEDURE....3 .... • Establishes policies/procedures that will reduce the spread of infections to employees and patients... 6. Hospice will perform a risk analysis to identify risks for the transmission and acquisition of infectious agents based on: • Geographic location and community served. • Results of analysis of infection prevention and control data. • Care provided... 9. Hospice will assign responsibility for infection control program management. • The assigned individual will be qualified for such responsibilities based on education, additional training and/or experience. • The individual coordinates all activities and assures ongoing surveillance, data collection, aggregation, analysis and monitoring of the effectiveness of the program. • The individual meets regularly with leaders, managers, and staff to: - Develop strategies. - Review and react (as appropriate) to surveillance data. - Assess successes and failures of program. Review and revise program. - Perform annual infection control program evaluation." The QON stated the policy was not followed.