Initial Comments:
Based on the findings of an onsite unannounced state license survey completed March 12, 2024, Tender Touch Home Health was found not to be in compliance with the following requirement of PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart G, Chapter 601, Home Health Care Agencies.
Plan of Correction:
601.31(b) REQUIREMENT
PLAN OF TREATMENT
Name - Component - 00
601.31(b) Plan of Treatment. The
plan of treatment developed in
consultation with the agency staff
covers all pertinent diagnoses,
including:
(i) mental status,
(ii) types of services and equipment
required,
(iii) frequency of visits,
(iv) prognosis,
(v) rehabilitation potential,
(vi) functional limitations,
(vii) activities permitted,
(viii) nutritional requirements,
(ix) medications and treatments,
(x) any safety measures to protect
against injury,
(xi) instructions for timely
discharge or referral, and
(xii) any other appropriate items.
(Examples: Laboratory procedures and
any contra-indications or
precautions to be observed).
If a physician refers a patient under
a plan of treatment which cannot be
completed until after an evaluation
visit, the physician is consulted to
approve additions or modifications to
the original plan.
Orders for therapy services include
the specific procedures and modalities
to be used and the amount, frequency,
and duration.
The therapist and other agency
personnel participate in developing
the plan of treatment.
Observations:
Based on review of agency policy, clinical records (CR), and staff (EMP) interview, the agency failed to ensure the plan of care included all medications the patient was taking for two (2) of two (2) clinical records with central venous catheters (CR1, & CR4).
Findings included:
Review of agency policy on March 12, 2024, at approximately 11 a.m. showed, "IV. B. Medication Profile ... The medication list is collectively maintained in the clinical record. The plan of care will demonstrate the patient's current medication regimen."
Review of CR1 on March 12, 2024, at 10:30 a.m. showed a physician ordered plan of care with a recertification period from 1/4/2024 to 3/3/2024. Orders included skilled nursing once a week for central line care, "Central line dressing change ... lab draws." During interview with EMP1 (agency administrator and registered nurse) at time of record review, he/she noted that he/she flushes CR1's central line (Broviac) with 5 ml (milliliter) of normal saline (a medication) and 3 ml of heparin (a medication to keep line from getting clogged with blood) during every weekly visit (8 visits total for this certification period). Further review of CR1's plan of care did not show normal saline or heparin listed.
Review of CR4 on March 12, 2024, at 11:15 a.m. showed a physician ordered plan of care with a recertification period of 1/7/2024 to 3/6/2024. Orders included skilled nursing once a week for central line care, "draw labs, central line dressing change." During interview with EMP1 at time of record review, he/she noted that he/she also flushes CR4's central line (Broviac) with 5 ml of normal saline and 3 ml of heparin during every weekly visit. This is done during every weekly visit (6 visits total for this certification period). Further review of CR4's plan of care did not show normal saline or heparin listed.
Interview with EMP1 on March 12, 2024, at 11:30 a.m. confirmed above findings.
Plan of Correction:A.) It is acknowledged that the medications, normal saline and heparin, does not show on the plan of care (485). It was believed that lab draws followed a standard operating procedure (SOP) and therefore was not required. It is our plan and intention to ensure that all medications and interventions are on the plan of care (485) going forward. We have verified with the ordering physician for both CR1 and CR4 that the flushes were in fact the correct amount and procedure for these patients. As such the plan of care (485) was re-issued with these corrections on 3/19/2024.
B.) It is our intention to safeguard all patients going forward by creating a checklist for the start of care to ensure that all medications and standard procedures that have been ordered by the physician are in place on the plan of care (485) as the start of care nurse conducts the Oasis.
C.) The checklist will be an addition of our current practice to ensure that this doesn't recur. As a secondary safeguard, the QA nurse will also use this checklist to ensure that everything ordered by the physician is on the plan of care (485). In this way, the nurse that conducts the patient visit has all the information in accordance with physician's orders.
D.) In our quarterly QA meetings, we will pull several patient charts to ensure that all relevant care, medications, etc. are being adhered to. Our next scheduled QA meeting was scheduled for 4/15/2024 however, we rescheduled it for 4/12/2024.
E.) Concerning the present deficiency, the medications have been verified by the ordering physician. The medications have been entered onto a new plan of care (485) and have been sent to the prescribing physician for signature on 3/19/2024. At the time of this writing 3:20PM on 3/19/2024, one of the corrected copies of the plan of care (485) has been returned with the physician's signature.
Due to the fact that we will be implementing a new checklist, it will require a special meeting of the board of directors. The first available date to conduct such meeting is April 12th, 2024. It is expected that at that time the new checklist will be adopted for use in our practice going forward. In order to ensure that this corrective action of this deficiency is effective and sustainable we will evaluate on 04/15/2024 after our next scheduled QA meeting which should have at least 4 weeks of QA notations concerning 485/POC.
Initial Comments:
Based on the findings of an onsite unannounced state license survey completed March 12, 2024, Tender Touch Home Health was found to be in compliance with the requirements of PA Code, Title 28, Health and Safety, Part IV, Health Facilities, Subpart A, Chapter 51.
Plan of Correction:
Initial Comments:
Based on the findings of an onsite unannounced state license survey completed March 12, 2024, Tender Touch Home Health was found to be in compliance with the requirement of 35 P.S. 448.809 (b).
Plan of Correction:
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