Volume 2025 | No. 2
SURVEYOR
HOME HEALTH
Compliance tips for:
Examples of ACHC Surveyor findings: ■ Plan of care (POC) does not include all types of services ordered. Referral indicates home health for SN, PT, OT. ■ Oxygen is in use but is not listed on the POC. ■ Medications listed on the plan of care are delivered subcutaneously. Safety measures do not include sharps safety. ■ The medication list includes IV medications without indicating the diluent, total volume, rate, or method of infusion. ■ Opioids are prescribed PRN without identifying a reason. ■ Order for catheter change did not include size of catheter and balloon, type of catheter, and when next catheter change is due. ■ Skilled nursing interventions and goals are missing. ■ POC goals state: “Pt will be able to identify correct dose route and frequency of each medication before end of episode and will be independent in med management by the end of episode.” Assessment documentation indicates “Patient is independent at self-administration of medication at admission.” POC includes “Patient will be free from pain during this cert period and will express pain less than 9 in 9 weeks.” Pain is documented as “not a problem for patient.” No reported acute pain or history of pain documented in record. ■ Plan of care includes blood glucose parameters to report to the physician. The patient does not have a diagnosis of diabetes or medication use for hyperglycemia. The order is not relevant to the patient’s medical status. ■ There is no documentation that the physician was consulted to approve the plan of care. ■ Orders failed to identify the discipline and frequency of care. ■ Plan of care did not include interventions or goals for home health aide but had a frequency.
The intent of this standard is patient safety. Through regular review of prescribed and OTC medications, home health staff are positioned to identify potential adverse effects and interactions. The profile is not a “one-and-done” situation. The standard states that drug regimen review is an ongoing part of patient care.
Nerd Newbies (understand the requirement)
■ A complete medication profile includes: ٝ All current patient medications. ٝ Date prescribed or taken ٝ Medication name ٝ Dose, route, frequency ٝ Date discontinued (if applicable) ٝ Drug or food interactions
■ Audit medication profiles with an eye toward incomplete orders to ensure accuracy and completion.
Nerd Apprentices (audit for excellence)
■ Reeducate staff on the responsibility to review all medications the patient is currently using and that review is a regular part of care. ■ When incomplete orders are noted, e.g., no indicators for PRN, best practice would require follow-up with the prescriber for additional detail to be added to the order.
Nerd Trailblazers (prepare the path for others)
HH5-3A Frequency of the citation: 57%
Overview of the requirement: Each patient has an individualized plan of care developed in consultation with the patient, physician (or allowed practitioner), and agency staff. The initial plan results from the comprehensive assessment, includes the discipline(s) providing care, measurable outcomes, and updates reflect revisions or additions. Comment on deficiencies: Compliance is evaluated through review of policies, procedures, and patient records. The plan of care requires consistent communication between multiple disciplines. This is a frequent deficiency due to the number of elements that must be included in the documentation. Most deficiencies resulted from incomplete medication orders or other missing information.
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