| 103 |
GUAM MEMORIAL HOSPITAL AUTHORITY |
655000 |
499 NORTH SABANA DRIVE |
BARRIGADA |
GU |
96913 |
2010-09-17 |
329 |
D |
0 |
1 |
7DPX11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not ensure that the drug regimen of each resident must be free from unnecessary drugs. An unnecessary drug is any drug when used without adequate monitoring or without adequate indications for its use. Findings include: 1. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the medical record revealed that the resident was admitted from the hospital where she was treated for [REDACTED]. The minimum data set ((MDS) dated [DATE] described the resident as having short-term memory problem, with moderately impaired cognitive skills for decision-making, and was dependent on staff for all activities of daily living (ADL). Review of the medical record revealed nurses notes that documented Resident 3 as being confused and "restless," including on 8/21/10, 8/29/10, 8/30/10, 9/01/10 and 9/02/10; as well as "yelling"and being "agitated" including on 8/16/10, 8/29/10 and 9/15/10. Review of the medical record revealed that on 8/15/10, physician's orders [REDACTED]. days." Review of the MAR (medication administration record) and nurses notes revealed that Resident 3 was given [MEDICATION NAME] for the behaviors, including 3 times on 8/16/10, once on 8/19/10, 8/19/10, 8/20/10, 8/21/10, twice on 9/01/10 and 9/02/10, and 9/04/10. Review of the medical record revealed a care plan dated 9/03/10 for "Behavior problem" which had a goal that Resident 3 "will have improved social behavior" by "less disruptive or socially inappropriate behavior." Interventions outlined in the care plan included coordinating "program of activities that minimizes the potential for inappropriate behavior;" monitor behavior to (assess) in determining cause;" and "use communication techniques such as explaining situation in advance, (and) praising progress." Notwithstanding the care plan however, review of the medical record revealed the lack of documentation of attempts by the facility to determine the cause of the resident's behavior. In addition, review of nurses and social service notes revealed the lack of written evidence that attempts were made to address or minimize the occurrence of the behaviors by non-drug interventions. Nurse notes including on 8/15/10, 8/16/10, 8/19/10, 8/20/10, 8/21/10, 8/29/10, 8/30/10, 9/01/10, and 9/15/10, for example, documented the administration of [MEDICATION NAME] 1 mg without noting attempts to determine the reasons for why Resident 3 was "agitated," was trying to get out of bed, calling out, yelling and/or whether the behaviors were minimized or addressed by removal of the cause or by use of non-drug interventions. In addition, record review revealed the lack of monitoring of the behaviors to determine the effect of interventions being implemented. During the survey, Resident 3 was frequently heard calling out to staff for assistance to get out of bed or go to the bathroom including on 9/15/10 at 1:30 p.m. when the she was heard from the hallway calling out "nurse ...nurse" repeatedly. When asked what she wanted, Resident 3 replied, "Help me up ...help me up. I want to go to the bathroom." At 3:30 p.m. on 9/15/10, Resident 3 was again observed calling out, "get me up ...I want to get up." At 10:35 a.m. on 9/16/10, the resident was heard, saying repeatedly, "I want to get up ...I want to get up." When asked what she wanted to do, the resident replied that she wanted to get out of bed. While care plan Interventions included coordinating a "program of activities that minimizes the potential for inappropriate behavior;" Resident 3 was observed in bed throughout the survey not engaged in any interaction with staff except when personal care was rendered or during meal times. While the medical record revealed no contraindication to her getting out of bed, Resident 3 was observed in bed at all times. Review of nurses notes dated 8/21/10, for example, revealed that Resident 3 was given [MEDICATION NAME] because "she dangles her legs over the bed and attempts to get down." No documentation was available to indicate why the resident wants to get out of bed and why this could not be accommodated by staff. 2. Resident 5 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. The resident's MDS dated [DATE] revealed the resident was awake, alert, and verbally responsive. The MDS also revealed that Resident 5 did not exhibit indicators of depression, anxiety, and sad moods. The resident was not identified to have any behavioral symptoms. A social services summary form dated 9/1/10 revealed that the social worker was informed by the facility's unit nursing supervisor that the resident was on "suicidal watch." The social worker met with the resident who assured her that she will not harm herself and that she was joking with one of the nurse aides that she will kill herself using the cord line in her room. The social worker noted that the resident was emotional during the interview; that she was depressed, and that the social worker was concerned about her placement upon discharge. Interviews with direct care givers of the resident indicated that they were not aware that the resident was on suicidal watch. There was no thorough assessment and plan of care for a resident on "suicidal watch" specific to Resident 5. A review of the admission orders [REDACTED]. A patient note dated 9/6/10 stated "Resident is being treated for [REDACTED]." The occupational therapist indicated that she had been involved in the activities of the residents. However, there was no documentation that the activities provided were designed to meet the interests of Resident 5 whose depressed mood had deteriorated to suicidal thoughts within one month period. A review of the physician's orders [REDACTED]. The Medication Administration Record [REDACTED]. Also, [MEDICATION NAME] 0.25 mg. was administered on 9/4, 9/5, 9/9, 9/10, 9/11, 9/12, 9/13, 9/14, 9/15, and 9/16/10. The medical record showed no documentation of non-drug intervention prior to administering the hypnotic drug. There was no documentation that attempts were made to determine the cause of Resident 5's inability to asleep without the use of the drug. |
2014-12-01 |