Volume 2024 | No. 2
SURVEYOR
HOME HEALTH
SECTION 7: RISK MANAGEMENT: INFECTION AND SAFETY CONTROL HH7-1A Overview of the requirement: HHA risk management policies address infection prevention and control. Comment on deficiencies: Evidence of compliance includes interview responses, review of policies, procedures, and patient records, and direct observations of care. Almost all deficiencies were cited during home visits and reflected improper hand hygiene. Surveyors also observed faulty equipment bag processes.
HH5-11F Overview of the requirement:
The duties of the home health aide are prepared by an RN or other appropriate skilled professional and implemented appropriately. Compliance is assessed through review of patient records and direct observation. Most deficiencies reflect a gap between the task list and the documentation of services provided. Task frequency was often missing.
Comment on deficiencies:
Frequency of citation:
15%
Examples of surveyor findings:
n During the home visit, the surveyor observed the aide administering medications through the g-tube and performs finger stick. The tasks performed by the aide are out of the scope of the aide and were not ordered to be provided. n Personnel records review did not have evidence that home health aide met the qualifications defined by Medicare’s Conditions of Participation. n Aide visit note did not have evidence that tasks were performed as ordered. n Aide care plan assigned task frequency “as needed,” but lacked specific statement that patient is cognitively and functionally able to make decisions: n Aide care plan denotes assisting with wheelchair while notes have assistance with walker documented. n Aide plan of care did not indicate the frequency for each task assigned. n The aide care plan didn’t contain vital sign parameters on when to contact the nurse. No information provided on when to notify the nurse of abnormal findings. n Aide care plan is incomplete and not signed by RN. n If the aide plan of care does not indicate frequency of tasks, it is incomplete. n Aides may only provide services that are ordered, included in their role- specific plan of care, permitted under state law, and consistent with their training. n “Per patient choice” can be used for tasks only if the RN assesses and determines that the patient is cognitively and functionally able to make the decision. PRN cannot be used. Home health aides are collaborative members of the interdisciplinary team. They provide hands-on care, update records, and communicate with other providers. Set these team members up for success. Provide in- depth training and competencies. Identify gaps in understanding. Offer additional education and support.
Frequency of citation:
21%
Examples of surveyor findings:
n RN conducting skilled visit did not cleanse hands prior to patient care. n During home visit, RN placed bag down without barrier between surface and home care visit bag and without cleaning surface prior to placing bag on surface. n Bag was open before and during visit with items spilling out of top. No evidence that HHA follows accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. n LVN went in and out of bag multiple times without hand sanitizing each time. n Nurse did not change gloves or perform hand hygiene after removing soiled dressing and before applying new dressing. n Nurse washed hands at patient’s bathroom sink using patient’s soap which was not antibacterial, then dried hands with the patient’s cloth hand towel n Nurse cleansed equipment with Lysol wipes and immediately placed them back into bag without allowing the required kill time. n Enforce accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. n Dev elop specific policies for hand hygiene and bag technique. Observe home visits periodically to assess compliance. n Educate staff on appropriate equipment cleaning procedures and disinfectant wait times.
Tips for compliance:
Tips for compliance:
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