| 1432 |
PRUITTHEALTH - FORSYTH |
115418 |
521 CABINESS ROAD |
FORSYTH |
GA |
31029 |
2019-11-04 |
880 |
E |
1 |
0 |
C2JS11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interviews and record reviews, the facility failed to maintain an infection control program that included thorough and complete surveillance for four residents (#12, #7, #11 and #8) of six residents treated with an antiparasitic medication between (MONTH) and (MONTH) 2019. Finding include: During an interview on 10/29/19 at 10:00 a.m. the Administrator confirmed that the facility had some residents who had experienced rashes and that the facility was thinking the cause was environmental. A review of the timeline of interventions implemented by the facility revealed that the following interventions had been implemented: 1)The concentration of detergent used in washing machine for laundry was decreased on 5/31/19 2) The washing machine was serviced to ensure proper chemical flushing on 5/31/19 3) Dermatologist consultations were obtained as ordered 4) Steroid medications were implemented as ordered 5) Body audits were completed on all residents on 9/15/19 6) Topical medication treatments were obtained as ordered 7) Ivermectin (antiparasitic) medication use was implemented as ordered 8) Deep cleaning of rooms as scheduled 9) Mattresses were inspected 10) Medications were reviewed verbally with the pharmacist the week of 10/14/19 11) [MEDICATION NAME] baby products including soap and lotion were added to the affected residents 12) Hospice Certified Nursing Assistants (CNA's) were asked not to bring in products 13) Ecolab was consulted for the use of any other available detergents A review of the pharmacy list of residents who were dispensed Ivermectin, an antiparasitic medication, for use, revealed five Residents (R) (#3, #10, #11, #12, and #7). A sixth resident, R#8, was also identified as receiving Ivermectin between (MONTH) 2019 and (MONTH) 2019. A review of the Line Listing for Infections, a part of the facility's Infection Control Program, revealed that R#3 and R#10 were included in the (MONTH) and (MONTH) line listings respectively for the use of the anti-parasite medication, Ivermectin, for a rash. R#3 visited the dermatologist on 3/27/19 and returned with an order to take six 3 milligram (mg) Ivermectin tablets in one single dose, then repeat it in one week and wash all bed linens the morning after taking the medication. A 3/27/19 Nurse Practitioner (NP) note documented that the resident had a papular rash to the neck, trunk and upper extremities. The NP also documented the rash was possibly scabies and that the resident saw the Dermatologist that day and received orders for Ivermectin. R#10 had a 4/17/19 NP note that documented a papular rash to the anterior trunk and extremities. On 4/22/19 the physician documented that the rash was still present and would be treated empirically for scabies with Ivermectin. A physician's orders [REDACTED]. R#12 was included in the line listing for (MONTH) for a symptom of itching. However, the listing for R#12 was not complete to include the medication treatment. In addition, R#7 and R#11 also received treatment with Ivermectin in (MONTH) 2019 but were not included in the line listing for that month. In addition, R#8 is not included in the line listing for (MONTH) 2019. 1. A review of the clinical record for R#12 revealed a 7/8/19 12:10 p.m. nurse note that documented the physician was notified of continued itching and small red rash-like bumps covering all extremities and trunk. A new order for Ivermectin was obtained. The physician ordered to administer six, 3 mg tablets of Ivermectin in one single dose, and repeat the dose again in one week. A review of the Medication Administration History for (MONTH) 2019 confirmed that the resident received the ordered doses of Ivermectin on 7/9/19 and 7/16/19. A review of the infection control program's Line Listing of Infections form for (MONTH) 2019 revealed that R#12 is included on the list for a symptom of itching. However, the remaining information on the line listing is incomplete. The entry does not include information on cultures, treatment, if the treatment was [MEDICATION NAME], if there is a true infection, the site of the itching or if it was a nosocomial or community acquired infection. 2. R#7 had physician's orders [REDACTED]. The resident was seen by a dermatologist on 5/1/19 and 5/15/19 and [DIAGNOSES REDACTED]. The orders for the [MEDICATION NAME] cream and [MEDICATION NAME] cream continued. A review of the 6/26/19 NP notes revealed that the NP documented the resident had no rash during that visit. However, on 7/8/19, the NP documented complaints of pruritic rash to the trunk and upper extremities. An [DIAGNOSES REDACTED]tous rash and scratch marks were noted to the trunk and upper extremities. The NP note documents that the resident was seen by dermatology twice and diagnosed with [REDACTED]. The NP notified the physician and documented they would treat with Ivermectin to see if there was any improvement. An order was written on 7/8/19 for licensed nursing staff to administer six 3 mg tablets of Ivermectin once on 7/8/19 and repeat the dose on 7/15/19. A review of the Medication Administration History for (MONTH) 2019 confirmed that the resident received the ordered doses of Ivermectin on 7/8/19 and 7/15/19. A further review of the clinical record after the completion of the Ivermectin revealed no further evidence of a recurrence of the rash. A review of the infection control program's Line Listing of Infections form for (MONTH) 2019 revealed that R#7 was not included in the listing for the rash and treatment with Ivermectin. 3. R#11 was examined by the NP on 7/2/19. A review of the 7/2/19 NP progress note revealed that the resident had a complaint of itching and rash. The skin was documented as having an [DIAGNOSES REDACTED]tous papular rash to trunk and extremities. The assessment and plan section noted pruritis and [MEDICAL CONDITION], scratching non-stop. A 4 mg intramuscular dose of [MEDICATION NAME] was ordered and six, 3 mg tablets of Ivermectin were ordered for a one-time dose, and to be repeated in one week. A follow up NP note on 7/8/19 documented that the resident's contact [MEDICAL CONDITION] rash and pruritis had improved with Ivermectin and that the next dose was due that week. Additional physician's orders [REDACTED]. An additional follow up NP note for a 7/16/19 visit documented that the contact [MEDICAL CONDITION] had resolved with treatment. A further review of the clinical record after the completion of the Ivermectin revealed no further evidence of a recurrence of the rash. A review of the infection control program's Line Listing of Infections form for (MONTH) 2019 revealed that R#11 was not included in the listing for the rash and treatment with Ivermectin. 4. R#8 was examined by the NP on 5/21/19. A review of the 5/21/19 NP progress note revealed that the resident complained of pruritis and had a papular rash to the arms and anterior chest wall. The note includes that the issue was discussed with the physician and a decision was made to treat the resident with Ivermectin. A physician's orders [REDACTED]. A review of the Medication Administration History for (MONTH) 2019 does not include documentation that the resident received the medication as scheduled. On 6/4/19, the physician visited the resident and documented that the resident continued to complain of an itching rash. His note included that the family indicated it seemed to have started after clothes were washed at the facility, instead of at home and that the family would wash the resident's clothes at home again. An order was written for [MEDICATION NAME] 1% cream to be applied twice daily. On 6/23/19 the NP visited and documented that the resident had no complaints of a rash that day and that the facility was washing laundry in a special detergent and to continue with [MEDICATION NAME] cream as needed. On 7/15/19 the NP documented that the rash had resolved. On 8/24/19 the NP again documented few erythemous, papular [MEDICAL CONDITION] noted on the trunk with a [DIAGNOSES REDACTED].#8 continued to complain of itching and a dermatology referral was made. The presence of the [MEDICAL CONDITION] was also noted on an 8/28/19 NP note. The resident visited the Dermatologist on 9/18/19. A 9/18/19 3:53 p.m. nurse's note entry documented that the resident returned from the appointment with new orders for [MEDICATION NAME] cream for suspected scabies. The note further includes that the NP called the dermatologist and the dermatologist stated that no scabies were seen. On 9/20/19 the NP documented that the resident had no rash noted but had scaly [MEDICAL CONDITION] to the dorsal surface of both hands. The NP noted that R#8 went to the dermatologist earlier in the week and was given a prescription for [MEDICATION NAME] cream for suspected scabies. The note includes that the resident was previously treated with Ivermectin. The NP note documents that the issue was discussed with the resident's family and the family declined treatment with the [MEDICATION NAME] cream and that nursing staff were to continue to use Lac-Hydrin lotion, cortisone cream and [MEDICATION NAME] medications as needed. On 10/30/19 the NP documented that the [MEDICAL CONDITION] had resolved. A review of the infection control program's Line Listing of Infections form for (MONTH) 2019 revealed that R#8 was not included in the listing for the rash and treatment with Ivermectin. |
2020-09-01 |