cms_GA: 10519
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10519 | MAGNOLIA MANOR METHODIST NSG C | 115004 | 2001 SOUTH LEE STREET | AMERICUS | GA | 31709 | 2009-08-20 | 428 | E | 3EK711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility failed to ensure that the resident's attending physician acted on the consultant pharmacist's recommendations in a timely manner for nine residents (#2, #3, #9, #18, #19, #20, #24, #27 and #30) from a total sample of 30 residents. Findings include: 1. Resident #18 had a 7/30/09 consultant pharmacist recommendation to increase the dose of Stalevo to aid in reducing the potential of falls and to change the time of the resident's Flomax from morning to hour of sleep to reduce any orthostatic hypotension to aid in reducing falls. However, the physician did not act on those recommendations until 8/19/09, at which time he/she increased the dose of Stalevo and changed the time of administering of Flomax to bedtime. 2. Resident #19 had a 3/26/09 consultant pharmacist recommendation for a [DIAGNOSES REDACTED]. However, the physician did not act on that recommendation until 5/27/09, at which time he/she gave a [DIAGNOSES REDACTED]. 3. Resident #20 had a 7/30/09 consultant pharmacist recommendation for the resident's Miralax be mixed with 8 ounces of water or juice according to the manufacturer's recommendations instead of the 4 ounces of liquid that the nursing staff had been administering. However, the physician did not act on that recommendation until 8/18/09, at which time he/she ordered nursing staff to give the Miralax with 8 ounces of water or juice. The resident also had a 6/30/09 consultant pharmacist recommendation for a potassium replacement due to the resident receiving HCTZ daily without a potassium supplement. The resident's 6/30/09 potassium level was low at 3.1 (normal range 3.5-5.3). However, the physician did not act on that recommendation until 7/15/09, at which time, he/she ordered 20 miliequivalents (meq) of KDur daily. During an interview on 8/20/09 at 8:30 a.m., licensed nurse "DD" stated that the consultant pharmacist gave the recommendations to the Director of Nursing, then they were copied and placed on the residents' charts. "DD" said that those recommendations were not reviewed and acted on until the resident's attending physician's next visit to the resident. 4. Review of resident #30's closed record revealed a 3/26/09 consultant pharmacist recommendation for a proton pump inhibitor (PPI) due to a recent hospitalization for a gastrointestinal bleed. However, the resident's attending physician did not act on that recommendation until 4/30/09. At that time, he/she ordered 40 milligrams of Protonix every day. 5. Resident #2 had consultant pharmacist recommendations dated 6/30/09 for a Complete Blood Count (CBC) to be done every six months due to the resident's previously low hemoglobin and hematocrit levels, and a recommendation to reduce the dosage of Atenolol from 100 milligrams (mgs) to 50 mgs daily due to the resident's renal insufficiency. However, review of the resident's clinical record revealed that although the physician had assessed the resident on 7/22/09, he/she had not acted on the recommendation for a CBC to be done every six months. After surveyor inquiry on 8/19/09, when supervisory nursing staff "EE" notified the physician about that consultant pharmacist's recommendation for a CBC every six months, he ordered the laboratory test to be done. Although the physician documented in his 7/22/09 progress notes that he did not change any of the resident's medications on that day, he failed to document his analysis of the risks versus the benefits from the resident's continued use of 100 milligrams of Atenolol every day. 6. Resident #3 had a physician's orders [REDACTED]. On 6/30/09, the consultant pharmacist recommended a dose reduction of the Ambien to 5 milligrams every night as needed. However, review of the resident's clinical record revealed that although the physician had assessed the resident on 7/22/09 and 8/12/09, he/she failed to act on that recommendation. 7. Resident #27 had a physician's orders [REDACTED]. On 6/30/09, the consultant pharmacist recommended that the order be clarified to 1 capful, or 17 grams, of Miralax in 8 ounces of water. However, review of the resident's clinical record revealed that the physician had failed to act on that recommendation. Resident #27 had a history of [REDACTED]. The resident had a physician's orders [REDACTED]. On 7/30/09, the consultant pharmacist recommended a reduction in the frequency of the Restoril to every night as needed or to change the medication to an alternative sleep aid. However, review of the resident's clinical record revealed that the physician had failed to act on that recommendation. On 8/19/09 at 11:30 a.m., supervisory nursing staff "EE" stated that nursing staff put the consultant pharmacist's recommendations on the residents' charts for the physicians to review. However, "EE" stated that none of the nursing staff was responsible for ensuring that the physicians saw those recommendations that had been placed on the charts. 8. Resident #24 had a 5/27/09 pharmacy recommendation that reported that since 5/7/09 nursing staff had been giving him/her Diabetic Robitussin every four hours around the clock. The pharmacist requested that the physician clarify if the medication was intended to be given around the clock or as needed. However, the physician did not act on the pharmacist's request until 7/8/09 when he/she ordered to discontinue the medication. 9. Resident #9 had a 7/30/09 pharmacy recommendation for a trial dose reduction of Zyprexa 5 milligrams twice a day and to evaluate if Zinc and Vitamin C were still indicated. However, as of 8/20/09, the physician had not acted on those recommendations. | 2014-04-01 |