cms_WV: 9184

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.

Data source: Big Local News · About: big-local-datasette

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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
9184 CORTLAND ACRES NURSING HOME 515063 39 CORTLAND ACRES LANE THOMAS WV 26292 2011-02-02 428 D 0 1 IEXL11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review, and staff interview, the facility failed to ensure one (1) of thirty-six (36) Stage II sample residents was free of the potential for excessive dosages of psychoactive medications due to duplicate therapy, when the pharmacist failed to recognize irregularities in his physician's orders [REDACTED]. Resident identifier: #28. Facility census: 90. Findings include: a) Resident #28 1. A review of Resident #28's medical record revealed this [AGE] year old female had [DIAGNOSES REDACTED]. Her physician's orders [REDACTED].>- 04/07/10 - (Ativan) Lorazepam 2 mg/ml solution injection Dose Ordered: (0.5 ml/1 mg) intramuscular 1 mg q.6.h. (every 6 hours) p.r.n. first date 03/01/2010 FOR: Agitation. - 08/30/10 - (Ativan) Lorazepam 1 mg Tablet by mouth (1) 2 X wk. Sunday Wednesday 8:00 am first date: 09/01/2010 FOR: Agitation and restlessness due to dementia Notify Staff. - 09/14/10 - Lorazepam 0.5 mg Tablet by mouth q.6.h. 8:00 am 2:00 pm 8:00 pm 2:00 am first date: 09/15/2010 FOR: Agitation and restlessness due to dementia Notify Staff. - 09/23/10 - (Risperdal) Risperidone 0.25 mg Tablet by mouth q.6.h. p.r.n. first date: 02/20/2010 FOR: Dementia-Related Psychosis, organic mental syndrome, (Dementia-Related Psychoses) with behaviors of yelling out, spitting, screaming and resistive of personal care Notify staff. - 09/23/10 - (Risperdal) Risperidone 1 mg Tablet by mouth daily 8:00 am FOR: Dementia-Related Psychosis (Dementia-Related Psychoses) organic mental syndrome with psychotic or agitated behaviors first date: 07/01/2010. -- 2. The resident's Medication Administration Record [REDACTED]. The MAR indicated [REDACTED]. Also, there were no times or cumulative dosage limits set for giving either the PRN Ativan or the PRN Risperdal along with the routine doses. -- 3. The facility policy entitled PRN MEDICATIONS, provided by the director of nurses at 8:00 a.m. on 02/02/11, stated: B. To assure the proper utilization of 'PRN' drug orders: 1. The frequency of normal use should be specified within the physician's orders [REDACTED]., q3hr PRN). This provides good guidelines to the nursing staff on how often a medication can and/or should be administered to be effective and sage. If a frequency of administration is not specified the order could be used too often or not often enough to achieve desired results. 4. The 'Indicators' published by Health and Human Services for surveyors say 'A pharmacist should comment on as needed (PRN) drug orders which are administered as directed every day for more than 30 days.' The meaning of this 'apparent irregularity' is that a physician's intent for PRN medications is that normally PRN orders should not be needed on a routine (daily) basis. 5. If a 'PRN' medication order has not been utilized in 60-90 days, the order should be re-evaluated by nursing for a possible recommendation to the physician for discontinuation. Therefore, 'PRN' orders that were appropriate three or more months ago might not be appropriate at the present time. 6. If a 'PRN' medication is NECESSARY to give daily, check with the prescriber to see if the order can be changed to a routine order. This will make the orders reflect the actual usage and will also save nurses the extra documentation involved with 'PRN' orders. -- 4. During an interview with a nurse supervisor (Employee #139) at 2:25 p.m. on 02/01/11, she agreed the orders for the PRN Ativan and PRN Risperdal needed parameters and that the frequent use of the PRN Risperdal should have been addressed. -- 5. A review of the resident's medication regimen reviews for August 2010 through January 2011 revealed the pharmacist failed to identify and/or question the Ativan and/or the Risperdal orders, either for frequency of use or for the lack of parameters for PRN use. 2016-01-01