cms_GA: 4789
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4789 | PRUITTHEALTH - FAIRBURN | 115506 | 7560 BUTNER ROAD | FAIRBURN | GA | 30213 | 2016-06-09 | 281 | D | 1 | 0 | WGW111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on complainant interview, staff interviews, and the facility Medication Administration Record [REDACTED]. Findings include: Resident E was admitted to the facility on [DATE] with multiple diagnosis, including: Weakness, [MEDICAL CONDITIONS] ([MEDICAL CONDITION]), high Cholesterol, [MEDICAL CONDITIONS], Dementia, Hypertension, Decreased appetite, [MEDICAL CONDITION] Ulcer, Chronic [MEDICAL CONDITION], Depression, Vascular Neurocognitive Disorder with Behavioral problems. The resident had a physician's orders [REDACTED]. Apply patch to skin every day. Remove old patch. Rotate site and do not repeat the site for fourteen (14) days. Review of the (MONTH) (YEAR) MAR indicated [REDACTED]. Review of the Five day, Minimum Data Set ((MDS) dated [DATE], revealed in Section C: Cognitive Pattern as unable to complete due to impaired cognitive status. Section G: Functional Status, A-J the resident was assessed for extensive assist. Interview on 5/18/16 at 10:30 a.m. with the Complaint D revealed that he had no further complaints other than the ones already voiced. He revealed that he had concerns about all of the patches being left on resident E and not being changed. He revealed that the staff could not have been assessing the resident and leaving all the medicine patches on her. Interview on 5/18/16 at 2:35 p.m. with Licensed Practical Nurse (LPN) BB of the 300 Hall revealed that she worked with resident E on (MONTH) 3rd, (YEAR). She revealed that she took off the old patch and put on a new one. She revealed that the old medication patch would have had a date of 4/2/16 written on it. She revealed that she had inservices on how to administer medication patches on (MONTH) 12, (YEAR). Interview on 5/18/16 at 3:15 p.m. with CNA EE of the 200 Hall revealed that she would report to the nurse if a resident have a lot of patches on. Interview on 5/19/16 at 9:15 a.m. with the Interim Administrator ZZ revealed that an investigation was completed on why the resident E had on extra patches. As a result, all nurses were inserviced on 4/12/16 and the sign in sheet was provided. Interview on 5/19/16 at 9:30 a.m. with LPN JJ by telephone revealed that she put the (MONTH) 6, (YEAR) patch on. She revealed that she removed a patch before she put the new one on. She revealed that she did not check the resident's whole body for any patches. She revealed that she had never put any patches any other place other than the resident's back and arm. She revealed that she attended an in-service on [MEDICATION NAME]es. Interview on 5/19/16 at 9:43 a.m. with LPN KK by telephone revealed that she worked the 11-7 shift. She revealed that she put on one (1) patch and remove the other patch. She revealed that the patch was scheduled for 6 a.m. in the morning; but, it was usually given at 9 a.m. rather than the scheduled time. She revealed that she has had an in-service on the [MEDICATION NAME] Patch. She revealed that her main responsibly for residents with patches, is to look at the whole body. Interview on 5/19/16 at 10:00 a.m. with LPN LL by telephone revealed that she looked for another patch on resident E. She revealed that she took off one (1) patch and put on a new patch on. She revealed that she assumed that the patch should be put on the upper back. She revealed that she has had an inservice on the patch. Interview on 5/19/16 at 11:00 a.m. with the Nurse Practitioner (NP) revealed that the some side of effects [MEDICATION NAME] are gastro-intestinal disturbances, nausea, and vomiting and can cause fatigue. She revealed that the patches should have been removed; and that the resident should never have on more than one patch. Review on the Medication Administration Record [REDACTED]. Apply one (1) patch to skin every day. Remove old patch (rotate site & do not repeat site for 14 days). (For [MEDICATION NAME]). Further review indicated that patch was applied to resident E on (MONTH) 1,2,3,4,5, and 6 , (YEAR) and that the site area was demonstrated by the number 1-31 to correspond with the [MEDICATION NAME] Patch Rotation Schedule chart. Review of the United Pharmacy Services [MEDICATION NAME] Patch Site Rotation Schedule indicated all [MEDICATION NAME] Patches need to be removed after 24 hours and replaced by a new patch. It further indicated that it is important for healthcare professionals to instruct patients and caregivers on the proper use of the [MEDICATION NAME] and particularly that: only one (1) [MEDICATION NAME] should be applied per day to healthy skin on only one of the recommended locations: the upper or lower back, or upper arm or chest; the patch should be replaced by a new one after 24 hours/ and the previous day's patch must be removed before applying a new patch to a different skin location.; to help minimize skin irritation, application to the same skin location within 14 days should be avoided. It further indicated that the site for all [MEDICATION NAME] Patches needs to be recorded daily on the MAR. Review on the Medication Record Sheet for resident F indicated Rivastigmine DIS 9.5 mg/24. Apply 1 patch to skin every day, Remove old patch (rotate site & do not repeat site for 14 days) For: [MEDICATION NAME]. At 9 a.m Review of the Medication Administration: [MEDICATION NAME] Drug Delivery System (PATCH) Policy: When administering medication via [MEDICATION NAME], nurses will follow current standards of practice to facilitate continuous medication absorption of the medication through the patient/resident's skin while the patch is in place. Nurses will provide proper care to the application site and application sites will be rotated per manufacturer's recommendations. Procedure and Key Points: #7. Observe site of previous patch application, gently remove old patch and dispose of according to health care center policy. #8. Select an appropriate site for application of new patch. Rotate site of application. Date and initial new patch before application. Review of the Inservice Education Program Summary record form dated 4/12/16 indicated an in-service on [MEDICATION NAME] Patches which was after the resident's admission to the hospital on [DATE]. Review of the State of Georgia Rules and Regulations for Standards of Practice for Licensed Practical Nurses (Rule 410-10-.02) (3) (a): Failing to maintain a patient record that accurately reflects the nursing assessment, care, treatment and other nursing services provided to the patient. | 2019-06-01 |