cms_WV: 4779
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4779 | HERITAGE CENTER | 515060 | 101-13TH STREET | HUNTINGTON | WV | 25701 | 2016-01-14 | 329 | D | 0 | 1 | D0ID11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of policies and procedures on Gradual Dose Reduction and Behavioral Monitoring, the facility failed to attempt a gradual dose reduction for Resident #87 and failed to offer nonpharmacologic interventions prior to administering an antianxiety medication to Resident #100. No behaviors were documented for either resident. This affected two (2) of five (5) residents sampled for the Care Area of Medication Review. Resident identifiers: #85 and #100. Facility census: 159. Findings include: a) Resident #85 Review of this resident's medical record on 01/14/16 at 8:41 a.m., found the resident had [DIAGNOSES REDACTED]. The most recent Minimum Data Set (MDS) assessment, dated 11/25/15, indicated the resident had Non-Alzheimer's Dementia and there were no behaviors identified on the quarterly assessment. The most recent care plan indicated the resident was at risk for complications related to [MEDICAL CONDITION] medication; staff would complete behavior monitoring flow sheets, gradual dose reduction as ordered, and monitor for continued need of medication. Continued medical record review on 01/14/16 at 8:47 a.m., found the physician's orders [REDACTED]. On 12/02/15, the consultant pharmacist completed a Consultation Report. The report included, Resident recently tolerated a reduction of [MEDICATION NAME] from 1 mg twice a day to 0.75 mg at noon and 1 mg at night on 4/24/15. Recommendation: Please consider a further reduction of antipsychotic therapy, [MEDICATION NAME] to 0.75 mg twice a day, with the end goal of discontinuation while concurrently monitoring for re-emergence of target and/or withdrawal symptoms. The document was signed by the nurse practitioner the response, I decline the recommendations above and do not wish to implement any changes due to the reasons below. Resident hospice and end of life. has continued [MEDICAL CONDITION]. Failed GDR (gradual dose reduction) in past. Would likely worsen quality of life. Review of the medical record, including nurses' notes and behavioral monitoring sheets, did not find evidence the resident had any episodes of behaviors. On 01/14/16 at 9:19 a.m., further review of the nurses' notes found a General Note dated, 05/13/15 at 3:43 a.m., Resident has had no adverse reactions noted due to decrease in [MEDICATION NAME]. Incontinent of bowel and bladder. Staff has been assisting resident to the restroom every two hours. Occasionally resident will remove her pull up and clothing while lying in bed. Resident unable to voice wants/needs and requires max (maximum) assistance with activities of daily living. Resting in bed at this time with no signs and symptoms of acute distress noted. In an interview on 01/14/16 at 8:50 a.m., the resident's nurse, Licensed Practical Nurse (LPN) #64, stated the resident had not displayed any behaviors. She stated the resident used to undress, but did not do that anymore. The LPN stated the resident ambulated in the halls with her walker and was easily re-directed. The LPN stated staff would document in nurses' notes and the behavioral flow sheets if behaviors occurred. The LPN stated the resident had not had any recent behaviors. On 01/14/16 at 9:22 a.m., Dementia Unit Manager #43, stated it would not be beneficial for the resident to have a dose reduction because of her history with failed attempts to reduce the medication. On 01/14/16 at 1:50 p.m., Director of Nursing (DON) #119 provided the facility's policy on Gradual Dose Reduction (GDR) Tapering Considerations. The policy stated a gradual dose reduction may be considered clinically contraindicated if the patient's target symptoms returned or worsened after the most recent attempt of a GDR with the center. The DON verified the policy was not followed after a successful gradual dose reduction that occurred when the [MEDICATION NAME] was reduced when recommendations were made on 4/24/15. b) Resident #100 On 01/13/2016 at 10:25 a.m., review of the resident's medical record found the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The most recent Minimum Data Set (MDS), dated [DATE], indicated the resident had received antianxiety medication and did not have any behaviors during the assessment period. On 01/13/2016 at 10:26 a.m., review of the most recent care plan resident was at risk for complications related to the use of [MEDICAL CONDITION] drugs as ordered. The care plan interventions included: complete behavior monitoring flow sheets, monitor for continued need of medication as related to behavior and mood, monitor for changes in mental status and functional level and report to physician and gradual dose reduction as ordered. Additional medical record review on 01/13/16 at 11:18 a.m., found the current physician's orders [REDACTED]. According to the resident's Medication Administration Records (MAR) for (MONTH) (YEAR) and (MONTH) (YEAR), the resident received the medication nine (9) times. There was no documentation on the MARs, nurses' notes, or on the Behavioral Flow Sheets, as to why the resident received the medication. On 01/06/16 and 01/09/16, the nurse documented the resident was pleasant. In an interview on 01/14/16 at 9:47 a.m., Licensed Practical Nurse (LPN) #37 verified the resident had a physician's orders [REDACTED]. She reviewed the MAR and stated the resident had received the medication. She stated there were behavioral monitoring sheets that were supposed to be completed if the medication was given to the resident. LPN #37 verified the behavioral flow sheets were blank, indicating there were no behaviors exhibited. Review of the MAR indicated the resident received the [MEDICATION NAME] 0.25 mg on (MONTH) 24 and 28, (YEAR) and on (MONTH) 1, 2, 6, 8, 9, 11, and 12, (YEAR). On 01/14/2016 at 10:48 a.m., during an interview, Director of Nursing (DON) #119 verified the nurses were supposed to document behaviors if a medication was given as needed for anxiety. On 01/14/2016 at 1:27 p.m., the DON provided a policy on Behavior Monitoring and Interventions. The DON verified: -- the policy was not followed when the resident received [MEDICATION NAME] 0.25 mg for anxiety without proper documentation of behaviors or why the resident received the medication for behaviors or anxiety -- there were no nonpharmacologic interventions attempted prior to the administration of the antianxiety medication -- the policy indicated to document nonpharmacologic interventions using the letter assigned to the intervention attempted -- the Behavioral Flow sheets were blank. According to the policy under the documentation requirements the last bullet indicated: Nursing completes documentation by exception only. No documentation indicates behavior did not occur on that shift/day. | 2019-07-01 |