cms_GA: 719

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

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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
719 BRIARWOOD HEALTH AND REHABILITATION CENTER 115322 3888 LAVISTA ROAD TUCKER GA 30084 2017-09-21 309 D 0 1 6G1L11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and resident, staff, and pharmacy interview, the facility failed to follow orders related to pain medication and failed to effectively manage the pain of one resident (#51) by immediately addressing barriers to having the resident's pain medication available to administer when scheduled and offering as needed pain medication. 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 [DATE] 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 [DATE], 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 [DATE] revealed interventions such as: administer pain medications prior to treatments and therapy, if indicated; 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 census history for R#51 revealed she was placed on Leave of Absence (LOA) from [DATE] and returned to the facility on [DATE] A review of the nurses' notes of [DATE] documented resident went on LOA on [DATE] at 8:00 p.m. to visit her daughter and that resident had medications to last until 1800 (6:00 p.m.) on [DATE]. A review of orders administration notes from [DATE] through [DATE] revealed the following was documented: [DATE] at 9:24 p.m. - Awaiting pharmacy to release medications. [DATE] 2:55 a.m. - [MEDICATION NAME] Tablet ,[DATE] mg, give 1 tablet by mouth every 6 hours for pain scheduled, medication unavailable, waiting for pharmacy. [DATE] at 7:12 a.m. - [MEDICATION NAME] Tablet ,[DATE] mg, give 1 tablet by mouth every 6 hours for pain scheduled, medication unavailable. A review of the nurses' notes for [DATE] at 6:32 p.m. revealed documentation that the nurse called the on-call nurse practitioner who advised that she was unable to generate a hard script for the medication, and the matter would need to be followed up with the MD's office during business hours on Monday. The note also documented that the resident was notified of this development. A review of orders administration notes from [DATE] revealed the following was documented: [DATE] at 12:09 a.m. - [MEDICATION NAME] Tablet ,[DATE] mg, give 1 tablet by mouth every 6 hours for pain, scheduled, meds not available waiting from pharmacy [DATE] at 6:09 a.m. - [MEDICATION NAME] Tablet ,[DATE] mg, give 1 tablet by mouth every 6 hours for pain, scheduled, not available from pharmacy [DATE] 12:47 p.m. - [MEDICATION NAME] Tablet ,[DATE] mg, give 1 tablet by mouth every 6 hours for pain, scheduled, waiting on pharm [DATE] 1:50 p.m. - Tylenol Tablet 325 mg, give 2 tablets by mouth every 6 hours as needed for mild pain or fever >100.5, PRN Administration was: Effective Interview on [DATE] at 11:15 a.m. with the pharmacist revealed if a resident returned from LOA with a scheduled pain medication such as [MEDICATION NAME] ,[DATE], this medication should be immediately available to the resident upon return. If, for some reason, the medication is not immediately available in the facility, the nurse can receive a stat order from the pharmacy which should arrive at the facility within two hours. The pharmacist was not sure what had occurred in this instance, but would look into the matter. Re-interview on [DATE] at 11:39 a.m. with the pharmacist revealed she had spoken to the pharmacy technician and this is what she believed had occurred: R#51 had a prescription for the [MEDICATION NAME] which expired on [DATE]. The MD- Dr. Frinks sent a PRN order for the [MEDICATION NAME] instead of a scheduled med order on [DATE] and the order was put in as such. When the resident returned from LOA on [DATE], [MEDICATION NAME] was not dispensed from the remote pharmacy system with the resident's routine medications; the nurse called the pharmacy and the pharmacy released the medications again; when the nurse contacted the pharmacy again and again to say the [MEDICATION NAME] had not been dispensed, the technician checked the prescription on file and noted that it was a PRN, not a routine medication order; at that point, the resident's physician was contacted and a prescription for the medication as a scheduled administration was obtained; the pharmacy then released the [MEDICATION NAME]. Interview on [DATE] at 4:00 p.m. with Licensed Practical Nurse (LPN) FF, ,[DATE] p.m. nursing supervisor revealed the resident returned from LOA late on [DATE]. He believes the resident arrived at the facility sometime after 6:00 pm. He was informed by the floor nurse that the resident's medications were not dispensed by the medication system/machine. He immediately called the pharmacy and was informed that the resident was showing as discharged in their system; the pharmacy would put her back into the system, but they needed copies of her orders to do so. LPN FF faxed this information to the pharmacy. When he returned to work on [DATE] on the ,[DATE] shift, he was informed by nursing staff that nursing staff that the resident's other medications were being dispensed by the pharmacy system, but the resident's scheduled pain medication was still not being made available for administration; LPN FF again called the pharmacy and was informed by pharmacy staff the resident needed a written prescription for the [MEDICATION NAME]; LPN FF next called the on-call nurse practitioner who informed him that the she could not obtain a new hard script for the medication until the following Monday. She did not have access to a hard copy of the prescription that needed to be sent to the pharmacy by the physician. The nursing supervisor informed the resident and the R#51's daughter that the pain medication would not be available and that staff would resolve as soon as possible on Monday. He recalls the resident was upset and said she had been on the medication for a while. LPN FF said he was told by the floor nurse that the resident had a PRN order for Tylenol 325 mg every 6 hours. He believes the nurse may have offered this PRN pain medication (Tylenol) to the resident, but is not sure. When the nursing supervisor came in on the 3:00 p.m. to 11:00 p.m. shift on Sunday, [DATE], he learned from staff that the resident's [MEDICATION NAME] medication was still not available. At that time, he called the pharmacy again spoke with the pharmacy personnel who said they could not proceed without a prescription. However, he reminded the pharmacy staff that the resident had been on this scheduled medication for some time, they were able to release three [MEDICATION NAME] pills for the resident on Sunday afternoon and the resident was administered one of these pills. The nursing supervisor, LPN FF said he does not recall whether [MEDICATION NAME] was listed as either a PRN or scheduled medication on the resident's order that he pulled and faxed to the pharmacy on Friday evening - [DATE]. He is not aware of another similar situation on the weekend and is not aware of any protocol for such a situation. He did not call the Medical Director or the Director of Nursing (DON). Review of the (MONTH) Medication Administration Record [REDACTED]. Review of the pharmacy dispense report for [DATE] revealed that three [MEDICATION NAME] ,[DATE] mg were dispensed for the resident at 3:53 p.m. on [DATE]. Interview on [DATE] at 5:00 p.m. with R#51 revealed she returned to the facility late on [DATE] and was informed by the night supervisor, LPN FF, that her pain medication was not available. She did not get her regular pain medication until 4:30 p.m. on Sunday, [DATE]. She said she was hurting all weekend. The resident said she only remembers being offered and having received PRN Tylenol only one time that weekend. She is not sure if this was on Saturday or Sunday. Review of the clinical records for R#51 revealed a pain level of zero was documented on [DATE] at 12:27 p.m.; pain level of 3 was documented on [DATE] at 12:47 p.m., and a pain level of 2 was documented on [DATE] at 5:50 p.m. Interview with the Director of Nursing (DON), CC, on [DATE] at 5:15 p.m. revealed that, if a resident returned from leave or is readmitted in the evenings or on the weekends and medications are not available/dispensed by the remote pharmacy system, nursing staff should contact the pharmacist and provide whatever documentation is required by the pharmacist to have the resident's medications dispensed. If a narcotic is involved, the pharmacist should call the resident's doctor for a written prescription. If a written prescription is not immediately available, the pharmacist can and should get a verbal order from the resident's doctor for a small quantity of those narcotics until a written order is available. If the pharmacist insists on a written prescription and the Physician is not available, the staff can reach out to the Medical Director or call the DON who would reach out to the Medical Director for a written prescription for the resident to receive his/her pain medication. Under no circumstances should the resident have to wait until the weekend is over to receive their pain medications to be released for administration. 2020-09-01