Initial Comments:
Based on the findings of an onsite unannounced Medicare complaint survey conducted November 30,2023, December 1, 2023, December 6, 2023, December 20,2023 and offsite December 22, 2023, December 29, 2023, and onsite January 4, 2024. Aveanna Healthcare was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.
Plan of Correction:
484.60(b) STANDARD
Conformance with physician orders
Name - Component - 00
Standard: Conformance with physician or allowed practitioner orders.
Observations:
Based on patient record review, review of agency policy, and an interview with the executive administrator the agency failed to ensure physician orders were followed for three (3) of five (5) patient records reviewed (PR #1, 2 and 4).
Findings include:
Review of agency policy occurred on January 4, 2023, at approximately 12:05 PM and revealed the following: Policy titled: Medication Administration Guidelines "All medications for patients administration will be ordered by a licensed healthcare provider with the ability to prescribe. This includes prescribed, over the counter and homeopathic/home remedies, nutritional supplements..............All orders for medications will contain the name of the drug, concentration, dosage, frequency, duration and route of administration. All medications given during the visit/shift are documented on the Medication Administration Record (MAR)". Medications not given or withheld: Medications either withheld or not given shall be documented on the MAR or progress note the reason not given".
Review of patient medication records took place on December 1, 2023, at approximately 9:02 am through 11:45 am and on January 4, 2024, at approximately 9:15 am through 10:57 am revealed the following: On the Home Health Certification and Plan of Care (485) contains medication orders and nutritional requirement were not followed per plan of care.
Patient Record # 1 SOC 11-05-2020 certification period from 11/4/2023 to 1/2/2024, medication order:
Fluticasone Propionate HFA (EQL Fluticasone Childrens) 50 mcg/act ml nasal give one spray in each nostril every morning. Medication not documented on the MAR on 11/4/23, 11/6/23, 11/7/23, 11/8/23 and 11/9/23 then patient was hospitalized.
Polyethylene Glycol 3350 (Miralax) 17 GM/Scoop G-tube give 8.5 grams (one half scope dissolved in water daily, constipation). Medication not documented on the MAR on 11/9/23.
Order for Nutritional requirement: Kate Farms 1.0 Peptide Formula 700 ml plus 600 ml free water, run continuously at 52 ml/hr. via G-tube. Monitor for signs and symptoms G-tube feeding intolerance. Position upright for feedings. Flush feeding tube with 10 ml water after meds and feeds. The nutritional flow rate order to run continuously at 52 ml/hr. was running at 56ml/hr. on 11/4/23, 11/6/23, 11/7/23, 11/8/23 and 11/9/23.
Patient Record # 2 SOC 01/22/2018 certification period from 10/14/2023 to 12/12/2023, medication order. Fluticasone Propionate HFA (Flovent HFA) 44 mcg/act inhalation administer 2 puffs via spacer twice per day. Medication not documented on the MAR on the following dates: 10/14/23, 10/15/23, 10/22/23, 10/23/23, 10/28/23, 10/29/23,10/30/23, 11/4/23,11/5/23, 11/9/23, 11/11/23, 11/12/23, 11/14/23, 11/16/23, 11/25/23,11/26/23,11/27/23,11/28/23.
Cetirizine HCL 1mg/ml G-tube administer 2.5mg (2.5 ml) twice per day. Medication not documented in the MAR for the entire certification period.
Chlorhexidine Gluconate 0.12% ml Mouth/throat apply small amount to mouth daily. Medication not documented on the MAR on the following dates: 10/14/23, 10/16/23, 10/17/23, 10/18/23, 10/20/23, 10/26/23,10/28/23, 10/29/23, 10/30/23, 10/31/23, 11/1/23,11/3/23,11/4/23,11/5/23,11/7/23,11/10/23,11/11/23,11/12/23,11/13/23,11/14/23,11/16/23,11/24/23,11/25/23,11/26/23,11/27/23, 11/28/23.
Patient Record # 4 SOC 02-01-2013 certification period from 10/14/2023 to 12/12/2023 medication order.
Cetirizine HCL 1mg/ml G-tube administer 5mg (5 ml) daily. Medication not documented on the MAR on the following dates: 10/16/23, 10/18/23, 10/19/23, 10/20/23,11/29/23.
An interview with the agency's administrator on January 4, 2024, at approximately 12:30 pm confirmed the above findings.
Plan of Correction:Action Taken: A process and guide will be developed showing detailed steps as to how to access the medication administration record (MAR) and document appropriately. This guide will include the steps and documentation required for when a medication is administered by a family member during the shift or within a reasonable timeframe of when the nurse would be considered responsible for accounting for the medication. Current documentation guides will be reviewed for instructions on how to access the patient's plan of care and physician orders as well as expectations of documenting to this plan of care.
Date the corrective action will be implemented: Education will be reviewed with the clinical support team at the weekly clinical meeting on 1/29/2024 prior to being sent out to the field staff as an electronic message by 1/31/2024. Paper copies of the education will be distributed to the clinical supervisors to give to individuals during supervisory visits and will be included with the documentation training presented to caregivers during orientation.
Monitoring Process: The clinical team will review a minimum of 2 notes on each case and 1 week of MAR entries prior to recertification visits with the patients and caregivers. Education will be provided and documented in the supervisory visits as appropriate, and issues will be noted on an internal audit tool. This will be reviewed quarterly for trends in documentation for further education as needed. The nursing director will audit 10 % of MARs and notes from each caregiver on a given case on a bimonthly (every other month) basis.
Initial Comments:
Based on the findings of an unannounced onsite complaint survey conducted November 30, 2023, December 1, 2023, December 6, 2023, December 20, 2023, and offsite December 22, 2023, December 29, 2023, and onsite January 4, 2024. Aveanna Health Care was found not to be in compliance with the requirements of 28 Pa. Code, Part IV, Health facilities, Subpart G. Chapter 601.
Plan of Correction:
601.31(d) REQUIREMENT
CONFORMANCE WITH PHYSICIAN'S ORDERS
Name - Component - 00
601.31(d) Conformance With
Physician's Orders. All prescription
and nonprescription (over-the-counter)
drugs, devices, medications and
treatments, shall be administered by
agency staff in accordance with the
written orders of the physician.
Prescription drugs and devices shall
be prescribed by a licensed physician.
Only licensed pharmacists shall
dispense drugs and devices. Licensed
physicians may dispense drugs and
devices to the patients who are in
their care. The licensed nurse or
other individual, who is authorized by
appropriate statutes and the State
Boards in the Bureau of Professional
and Occupational Affairs, shall
immediately record and sign oral
orders and within 7 days obtain the
physician's counter-signature. Agency
staff shall check all medicines a
patient may be taking to identify
possible ineffective drug therapy or
adverse reactions, significant side
effects, drug allergies, and
contraindicated medication, and shall
promptly report any problems to the
physician.
Observations:
Based on patient record review, review of agency policy, and an interview with the executive administrator the agency failed to ensure physician orders were followed for three (3) of five (5) patient records reviewed (PR #1, 2 and 4).
Findings include:
Review of agency policy occurred on January 4, 2023, at approximately 12:05 PM and revealed the following: Policy titled: Medication Administration Guidelines "All medications for patients administration will be ordered by a licensed healthcare provider with the ability to prescribe. This includes prescribed, over the counter and homeopathic/home remedies, nutritional supplements..............All orders for medications will contain the name of the drug, concentration, dosage, frequency, duration and route of administration. All medications given during the visit/shift are documented on the Medication Administration Record (MAR)". Medications not given or withheld: Medications either withheld or not given shall be documented on the MAR or progress note the reason not given".
Review of patient medication records took place on December 1, 2023, at approximately 9:02 am through 11:45 am and on January 4, 2024, at approximately 9:15 am through 10:57 am revealed the following: On the Home Health Certification and Plan of Care (485) contains medication orders and nutritional requirement were not followed per plan of care.
Patient Record # 1 SOC 11-05-2020 certification period from 11/4/2023 to 1/2/2024, medication order:
Fluticasone Propionate HFA (EQL Fluticasone Childrens) 50 mcg/act ml nasal give one spray in each nostril every morning. Medication not documented on the MAR on 11/4/23, 11/6/23, 11/7/23, 11/8/23 and 11/9/23 then patient was hospitalized.
Polyethylene Glycol 3350 (Miralax) 17 GM/Scoop G-tube give 8.5 grams (one half scope dissolved in water daily, constipation). Medication not documented on the MAR on 11/9/23.
Order for Nutritional requirement: Kate Farms 1.0 Peptide Formula 700 ml plus 600 ml free water, run continuously at 52 ml/hr. via G-tube. Monitor for signs and symptoms G-tube feeding intolerance. Position upright for feedings. Flush feeding tube with 10 ml water after meds and feeds. The nutritional flow rate order to run continuously at 52 ml/hr. was running at 56ml/hr. on 11/4/23, 11/6/23, 11/7/23, 11/8/23 and 11/9/23.
Patient Record # 2 SOC 01/22/2018 certification period from 10/14/2023 to 12/12/2023, medication order. Fluticasone Propionate HFA (Flovent HFA) 44 mcg/act inhalation administer 2 puffs via spacer twice per day. Medication not documented on the MAR on the following dates: 10/14/23, 10/15/23, 10/22/23, 10/23/23, 10/28/23, 10/29/23,10/30/23, 11/4/23,11/5/23, 11/9/23, 11/11/23, 11/12/23, 11/14/23, 11/16/23, 11/25/23,11/26/23,11/27/23,11/28/23.
Cetirizine HCL 1mg/ml G-tube administer 2.5mg (2.5 ml) twice per day. Medication not documented in the MAR for the entire certification period.
Chlorhexidine Gluconate 0.12% ml Mouth/throat apply small amount to mouth daily. Medication not documented on the MAR on the following dates: 10/14/23, 10/16/23, 10/17/23, 10/18/23, 10/20/23, 10/26/23,10/28/23, 10/29/23, 10/30/23, 10/31/23, 11/1/23,11/3/23,11/4/23,11/5/23,11/7/23,11/10/23,11/11/23,11/12/23,11/13/23,11/14/23,11/16/23,11/24/23,11/25/23,11/26/23,11/27/23, ,11/28/23.
Patient Record # 4 SOC 02-01-2013 certification period from 10/14/2023 to 12/12/2023 medication order.
Cetirizine HCL 1mg/ml G-tube administer 5mg (5 ml) daily. Medication not documented on the MAR on the following dates: 10/16/23, 10/18/23, 10/19/23, 10/20/23,11/29/23.
An interview with the agency's administrator on January 4, 2024, at approximately 12:30 pm confirmed the above findings.
Plan of Correction:Action Taken: A process and guide will be developed showing detailed steps as to how to access the medication administration record (MAR) and document appropriately. This guide will include the steps and documentation required for when a medication is administered by a family member during the shift or within a reasonable timeframe of when the nurse would be considered responsible for accounting for the medication. Current documentation guides will be reviewed for instructions on how to access the patient's plan of care and physician orders as well as expectations of documenting to this plan of care.
Date the corrective action will be implemented: Education will be reviewed with the clinical support team at the weekly clinical meeting on 1/29/2024 prior to being sent out to the field staff as an electronic message by 1/31/2024. Paper copies of the education will be distributed to the clinical supervisors to give to individuals during supervisory visits and will be included with the documentation training presented to caregivers during orientation.
Monitoring Process: The clinical team will review a minimum of 2 notes on each case and 1 week of MAR entries prior to recertification visits with the patients and caregivers. Education will be provided and documented in the supervisory visits as appropriate, and issues will be noted on an internal audit tool. This will be reviewed quarterly for trends in documentation for further education as needed. The nursing director will audit 10 % of MARs and notes from each caregiver on a given case on a bimonthly (every other month) basis.
|