cms_GA: 718
Data source: Big Local News · About: big-local-datasette
rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
718 | BRIARWOOD HEALTH AND REHABILITATION CENTER | 115322 | 3888 LAVISTA ROAD | TUCKER | GA | 30084 | 2017-09-21 | 282 | D | 0 | 1 | 6G1L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and resident and staff interview, the facility failed to follow the plan of care related to pain management for one resident (#51). The sample size was 32. Findings include: Review of the clinical records for Resident (R)#51 revealed a current [DIAGNOSES REDACTED]. Review of the most recent Minimum Data Set MDS) assessment, a quarterly, dated 8/14/17 revealed the resident was assessed as having a Brief Interview for Mental Status (BIMS) score of 15, indicating the resident was cognitively intact. On the quarterly MDS assessment of 8/14/17, R#51 was also assessed as receiving scheduled pain medications, receiving no non-medication interventions for pain, and experiencing severe pain almost constantly that could affect day-to-day activities and/or make it difficult to sleep at night. A review of the R#51's plan of care for chronic pain related to chronic pai[DIAGNOSES REDACTED], last updated 8/24/17 revealed interventions such as: anticipate the resident's need for pain relief and respond immediately to any complaints of pain; evaluate the effectiveness of pain interventions; observe/document for side effects of pain medication; observe/record pain characteristics during rounds and as needed: Quality (e.g. sharp); Severity (1 to 10 scale); observe/record/report to the nurse the resident complaints of pain or requests for pain treatment. A review of the clinical records for R#51 revealed she returned from a leave of absence to visit her family on 9/15/17. A further review of the resident's clinical records revealed that the resident's scheduled pain medication - [MEDICATION NAME] 5-325mg was not dispensed by the remote pharmacy system with the resident's other prescribed medication between 9/15/17 at 9:24 p.m. and 9/17/17 at 3: 53 p.m. due to the unavailability of a current written prescription. During this time, the staff did not: anticipate the resident's need for pain relief by having the resident's scheduled pain medication available; respond immediately to complaints of pain; offer other available pain management interventions such as PRN pain relief, except for one instance on 9/17/17. | 2020-09-01 |