cms_WV: 10706
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10706 | GUARDIAN ELDER CARE AT WHEELING, LLC | 515002 | 20 HOMESTEAD AVENUE | WHEELING | WV | 26003 | 2009-08-20 | 157 | D | 0 | 1 | S2JZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, medical record review, and staff interview, the facility failed, for one (1) of twenty-one (21) sampled residents, to ensure a resident's oncologist was notified when both pain and nausea medications were not effective. Resident identifier: #13. Facility census: 138. Findings include: a) Resident #13 1. During an initial tour of the facility on 08/17/09 at 1:00 p.m., observation found Resident #13 lying in bed with facial grimacing and guarding. A meal tray was observed on the bed side table set up, but the food was not touched. When interviewed at this time, Resident #13 reported, "I am so sick at my stomach." When asked if she had pain, she reported having intermittent stomach pain and pain in her breast, pointing to her right breast. When asked if they were giving her medications, she said yes but reported the pain and nausea medications were not working. On 08/17/09 at 2:00 p.m., medical record review revealed Resident #13 had been diagnosed with [REDACTED]. In July 2009, she was admitted to the hospital and had surgery on her breast, for which a drain was placed. The medical record also noted she had a abscess of the breast, and the [MEDICAL CONDITION] treatments had left [MEDICAL CONDITION] her breast abdomen and back. The orders for [MEDICAL CONDITION] and [MEDICAL CONDITION] were placed on hold. She returned to the facility on [DATE] and, since then, the [MEDICAL CONDITION] and [MEDICAL CONDITION] treatments have remained on hold. The medical record indicated that, on 07/30/09, her family physician (not her oncologist) was notified the medication [MEDICATION NAME] was not effective in relieving her pain. On 07/30/09, an order was received to increase the frequency of the [MEDICATION NAME] from every six (6) hours to every four (4) hours for pain. On 08/14/09, her family physician (not her oncologist) was notified the medication [MEDICATION NAME] was not effective in relieving her nausea, and he increased the frequency from of that medication from every eight (8) hours to every four (4) hours for nausea. -- According to http://www.rxlist.com/[MEDICATION NAME]-drug.htm, [MEDICATION NAME] is indicated for use for the following: - Prevention of nausea and vomiting associated with highly [MEDICAL CONDITIONS], including cisplatin ? 50 mg/m?. - Prevention of nausea and vomiting associated with initial and repeat courses of moderately [MEDICAL CONDITIONS]. - Prevention of nausea and vomiting associated with radiotherapy in patients receiving either total body [MEDICAL CONDITION], single high-dose fraction to the abdomen, or daily fractions to the abdomen. - Prevention of postoperative nausea and/or vomiting. As with other antiemetics, routine [MEDICATION NAME] is not recommended for patients in whom there is little expectation that nausea and/or vomiting will occur postoperatively. In patients where nausea and/or vomiting must be avoided postoperatively, [MEDICATION NAME] Tablets, [MEDICATION NAME][MEDICATION NAME](orally disintegrating tablets), and [MEDICATION NAME] Oral Solution are recommended even where the incidence of postoperative nausea and/or vomiting is low. The facility failed to contact the resident's oncologist in order to inform him that the [MEDICATION NAME] was not effective for nausea, especially since this medication is specific to use in conjunction with [MEDICAL CONDITION] and [MEDICAL CONDITION] treatments, which had been placed on hold. -- According to http://www.rxlist.com/[MEDICATION NAME]-drug.htm., for [MEDICATION NAME] indications and dosages: - Dosage should be adjusted according to the severity of the pain and the response of the patient. However, it should be kept in mind that tolerance to [MEDICATION NAME] can develop with continued use and that the incidence of untoward effects is dose related. - The usual adult dosage is one (1) or two (2) tablets every four (4) to six (6) hours as needed for pain. The total daily dosage should not exceed eight (8) tablets. Review of the Medication Administration Record [REDACTED]. On 08/17/09 at 3:00 p.m., a licensed nurse (Employee #119), when interviewed at the nursing station, identified that Resident #13's [MEDICAL CONDITION] and [MEDICAL CONDITION] treatments had been on hold for approximately two (2) weeks, and she confirmed Resident #13's oncologist had not been notified that the nausea and pain medications were not effective. Employee #119 also identified Resident #13 was getting two (2) [MEDICATION NAME] tablets every four (4) hours for pain, she had not been eating much, and Employee #119 was not sure if the [MEDICATION NAME] was causing Resident #13's nausea. The facility failed to contact the oncologist when Resident #13 was experiencing unrelieved pain and nausea, in order to identify alternative interventions. 2. On 08/17/09, following surveyor intervention, the oncologist was called and the nausea medication was changed to [MEDICATION NAME] 10 mg by mouth three (3) times a day. When interviewed on the morning of 08/18/09, Resident #13 related that the new nausea medication was working and this was the first time in days she was not nauseated. 3. On the morning of 08/18/09, facility management staff (Employees #138 and #139) were questioned about the high dosage of [MEDICATION NAME] with unrelieved pain and the possibility that the [MEDICATION NAME] may have been causing or contributing to the resident's nausea. The physician was notified, and Resident #13 was started on a [MEDICATION NAME] 25 mg pain patch and [MEDICATION NAME] sulfate liquid medication for pain. On 08/19/09, following an outside appointment, observation found Resident #13 resting quitely in bed with no grimacing, guarding, or nausea noted. . | 2014-12-01 |