cms_GU: 47
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 47 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2014-09-19 | 329 | D | 0 | 1 | OCYD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure that each resident's drug regimen must be free of unnecessary drugs for 2 of 8 sampled residents (Residents 1 and 2). Failure to secure appropriate physician orders [REDACTED]. Findings include: 1. On 9/17/14, Resident 1's medical records were reviewed with licensed nurse (LN) 1 and 2. Both nurses acknowledged the resident's current medications orders included [MEDICATION NAME] and [MEDICATION NAME]. The current [MEDICATION NAME] order dated 9/01/14 was written as [MEDICATION NAME] 2 mg orally twice to day. The current [MEDICATION NAME] order dated 9/09/14 was 0.5 mg orally twice a day. Both licensed nurses acknowledged the [MEDICATION NAME] nor the [MEDICATION NAME] contained indications for the use of the medications. During further investigation it was determined that Resident 1 was receiving the [MEDICATION NAME] and [MEDICATION NAME] related to behaviors. The minimum data set for Resident 1 listed behaviors such hitting, scratching, and screaming. When the licensed nurses were questioned how staff would document the number of behaviors per day, week, or month, the licensed nurses stated one would have to read all the nurses notes for the day, week, or month to quantify the number of behaviors for any specific time period. When the licensed nurses were questioned how they would document and quantify the number of adverse events for the [MEDICATION NAME] or [MEDICATION NAME] it was determined that once again one would have to read the nurses notes for that specific period of time. Furthermore, LN 1 stated that the facility was relying on the nurse's professional judgment to determine if adverse effects were occurring or not. That is, there was no list of specific adverse effects that may be associated with [MEDICATION NAME] or [MEDICATION NAME] that may facilitate a nursing action if a specific adverse affect was noted to be occurring. The licensed nurses concurred the current system for monitoring behaviors or adverse effects was not conducive to quantifying the number of adverse effects or behaviors in a day, week, or month and the aforementioned could potentially subject the residents to the use of unnecessary drugs. 2. Resident 2 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. The resident was also noted as having a right below-knee amputation and described in the initial minimum data set ((MDS) dated [DATE] as having no cognitive impairments and dependent on staff for most activities of daily living with one-person physical assist. Review of the medical record revealed that Resident 2 had a physician's orders [REDACTED]. The Medication Administration Record [REDACTED]. Further review revealed that the medication had been re-ordered monthly since 6/27/14. Review of the medical record revealed that while the resident was being given Klonopin, there was no documentation of attempts to determine the cause of the [MEDICAL CONDITION] and how these could be minimized or addressed by the use of non-drug interventions. In addition, a care plan for the problem of [MEDICAL CONDITION] was not developed outlining interventions that might help promote sleep. While nurses notes at times documented that non-drug interventions did not help, the notes however did not identify specific care plan interventions that were used or why they were ineffective. During an interview on 9/16/14, Resident 2 stated that there were nights when he felt uncomfortable from pain on his back and buttocks; and that noise at night, especially during shift change kept him awake. In the same interview, the resident added that because he also worked as a night shift security guard for 4 years that his circadian rhythm had been turned around. There was no documentation in the medical records that these factors were considered prior to the use of Klonopin. Further review of the medical record revealed the lack of evidence that monitoring of the cause and incidence of [MEDICAL CONDITION] was being conducted as well as the potential adverse effects of Klonopin, a benzodiazepine used to control [MEDICAL CONDITION] in [MEDICAL CONDITION] and for the treatment of [REDACTED]. Without monitoring and supporting documentation, the use of the Klonopin is rendered unnecessary because of the lack of indication and monitoring. | 2019-04-01 |