cms_WV: 5591
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5591 | HERITAGE CENTER | 515060 | 101-13TH STREET | HUNTINGTON | WV | 25701 | 2014-12-12 | 428 | D | 0 | 1 | VNJW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to act upon a consultant pharamacist recommendation for two (2) of six (6) residents reviewed for the care area of unnecessary medications during Stage 2 of the Quality Indicator Survey (QIS). The consultant pharmacist made a recommendation to decrease Resident #201's Celexa from 20 milligrams twice daily to 20 milligrams one time a day. The attending physician accepted the pharmacist recommendation on 08/18/14, but the facility failed to implement the medication change. For Resident #72 the facility failed to address the pharmacist recommendations related to an as needed anti-anxiety medication. Resident Identifiers: #201 and #72. Facility Census: 154. Findings Include: a) Resident #201 A review of Resident #201's medical record at 1:42 p.m. on 12/10/14 revealed a current physician's orders [REDACTED]. The medical record also contained a consultation report from the consultant pharmacist dated 08/06/14 which contained the following text (typed as written): Recommendation: Please consider decreasing citalopram (celexa) to 20 mg orally daily. Following any gradual dose reduction attempt, residents should be closely monitored for re-emergence of target symptoms and/or withdrawal symptoms. If symptoms emerge, alternative or adjunctive therapy may be warranted. Rationale for recommendation: An FDA (food drug administration) safety alert released (MONTH) 28, 2012, states that the maximum dose of citalopram for patients greater than [AGE] years of age is 20 mg daily due to the potential risk of abnormal heart rhythms with higher doses . Resident #201's attending physician reviewed and accepted this recommendation as written on 08/18/14. The physician indicated the recommendation should have been implemented as written. The consultation report was signed by the director of nursing (DON) on 08/19/14. Review of Resident #201's physician orders [REDACTED]. The resident has continued to receive Celexa 20 mg twice daily since this recommendation on 08/18/14. An interview with the DON at 3:18 p.m. on 12/10/14, confirmed the recommendation to decrease Resident #201's Celexa to 20 mg daily was never implemented as recommended by the pharmacist and accepted by the physician. b) Resident #72. On 12/10/14 at 1:42 p.m., review of the pharmacist's found a recommendation with an issue date of 07/01/14. It noted Resident #72 had received alaprazolam (Xanax) 0.25 milligram (mg) daily and 0.25 mg every eight (8) hours whenever needed (PRN) for anxiety. The physician's maked an X on the consultation report on 08/20/14 to continue medication and the physician writes the rationale is Worsening anxiety and insomnia off meds. The physician addressed only the use of the daily Xanax, no rationale for continuing the PRN medication of Xanax. On 11/06/14 the pharmacist make another recommendation to consider discontinuing due to lack of use: Anusol, Chloroseptic, milk of magnesium, Orajel, Xanax, and Norco was the PRN medication on the list. The physician on 11/24/14 did not make a rationale for continuing the PRN medication Xanax. The physician writes again on the 11/06/14 pharmacist recommendation on 12/09/14, I decline the recommendation above and do not wish to implement any changes due to the reason below. In the reason below spaces the physician left the area blank. No rationale was made by the physician regarding the PRN medication Xanax. Review of Resident #72's Medication Administration Record [REDACTED]. In an interview on 12/11/14 at 10:19 a.m., the director of nursing (DON) was asked whether the physician provided a rationale for continuing the PRN medication Xanax in response to the pharmacist's recommendation on 07/01/14, and again on 11/06/14. The DON said she would need to review the records first. On 12/11/14 at 11:10 a.m., the DON sent Registered Nurse (RN) #65 to relay the message the DON could not find any evidence the physician had documented a rationale for continuing the PRN medication Xanax. | 2018-09-01 |