| 74 |
HALE MAKUA - KAHULUI |
125007 |
472 KAULANA STREET |
KAHULUI |
HI |
96732 |
2019-11-26 |
758 |
D |
0 |
1 |
6SOG11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview with staff members, the facility failed to address the gradual dose reduction and use of an antipsychotic to treat a specific condition for 1 of 5 (Resident 189) residents reviewed for unnecessary medication. The facility inconsistently monitored the resident's targeted behaviors for use of [MEDICATION NAME], the targeted behaviors to address the use of [MEDICATION NAME] was changed over a period of time which does not provide accurate monitoring of the targeted behaviors related to the drug usage. Also, the start date of the medication was inconsistent, therefore, there was no documentation by the pharmacist of a recommendation for gradual dose reduction and the pharmacist did not address the increase of the [MEDICATION NAME]. Findings include: Resident (R)189 was admitted to the facility following an acute hospitalization on [DATE]. R189's [DIAGNOSES REDACTED]. R189 also has an indwelling foley catheter. On 11/19/19 during the initial tour, R189 was observed laying in bed asleep. Subsequent observation at 02:14 PM found the resident lying in bed with a pillow between his legs. On 11/20/19 at 09:10 AM, R189 was observed to be asleep in bed with the television on. At 11:30 AM, R189 appeared awake and attempted to screen the resident for appropriateness of interview. R189 attempted to sit up, setting off his clip alarm, a staff member entered the room and he asked whether lunch was coming. Inquired if he was hungry, he replied no. The screening was discontinued. Later stopped in to visit the resident at 02:15 PM, he was lying in bed asleep. A record review done on 11/22/19 at 07:35 AM noted physician orders [REDACTED]. (start date of 07/22/19) at hour of sleep for [MEDICAL CONDITION] with behavioral disturbance; and [MEDICATION NAME] 50 mg. (start date of 06/30/19) twice a day for [MEDICAL CONDITION] with behavioral disturbance. A review of the [MEDICAL CONDITION] medication review found the recorded date a medication was initiated is inconsistent. The review for 08/23/18 has an initiation date of 07/31/18 for [MEDICATION NAME] (50 mg. twice a day). A subsequent review, dated 06/24/19 for [MEDICATION NAME], the same dosage documents an initiation date of 05/25/18. There is also documentation of [MEDICATION NAME] 100 mg at bedtime in the review for 08/23/18 and 01/29/19. On 06/29/19 the [MEDICATION NAME] dosage was changed to 50 mg at bedtime. Subsequently, the dosage was increased to 150 mg at night on 06/30/19 as documented in the 10/28/19 assessment. There is no documentation of a gradual dose reduction. Also, the pharmacist is not documented as a participant in all the [MEDICAL CONDITION] medication review meetings. Further review of the [MEDICAL CONDITION] medication review found the monitoring of targeted behaviors related to the use of the medications varied. The targeted behaviors identified for the use of [MEDICATION NAME], 50 mg twice a day include: restlessness, anxiety, and calling for wife (08/23/18); yelling, aggressive talking, wandering and disorientation (01/29/19); exit seeking, yelling and verbalizing accusations (06/24/19); and agitation, yelling, exit seeking and throwing personal belongings (10/28/19). The use of [MEDICATION NAME] at bedtime identified the following targeted behaviors: 50 mg - falling asleep and staying asleep (06/24/19); 100 mg - yelling aggressive talking, wandering and disorientation (08/13/18); and 150 mg. agitation, yelling, exit seeking, and throwing personal belongings (10/28/19). The review also documents the number of occurrences of the targeted behavior which determines whether an increase of medication or a gradual dose reduction is indicated. On 11/25/19 at 09:20 AM an interview was conducted with Neighborhood Supervisor (NS)1. Inquired how does the facility monitor residents' targeted behavior. It was explained the nursing staff documents a progress note when a resident exhibits a behavior. NS1 further reported the ADON will count the target behaviors for the [MEDICAL CONDITION] medication review meetings to document the number of occurrences since the last review. NS1 clarified the ADON has to go through the resident's record to calculate the occurrences. A review of R189's care plan found interventions under Mood and Behavior for the interdisciplinary team to recommend gradual dose reduction based on the following: target behaviors are no longer present; target behaviors no longer affect the health and safety of the resident and/or others; target behaviors are successfully redirected with use of non-pharmacological interventions; and whether the side effects/risks outweigh the benefits of treatment. A review of the pharmacist drug regimen review found notification on 04/20/19 regarding consideration of dose reduction for [MEDICATION NAME] (15 mg qd since 06/25/18). The subsequent note of 05/19/19 documents [MEDICATION NAME] at 22.5 mg. The review does not address the increase of [MEDICATION NAME] from 100 mg to 150 mg at bedtime. The review on 07/16/19 notes possibly re-evaluate co-administration of [MEDICATION NAME] and [MEDICATION NAME] due to recent suicidal tendency. Also noted on the 08/07/19 review, consideration of tapering of [MEDICATION NAME] to discontinue started due to geri-psych evaluation (polypharmacy). Further noted resident found on floor on 07/18/19 at 07:00 AM. The review does not address the increase of [MEDICATION NAME] from 100 mg to 150 mg on 07/22/19 at bedtime. The pharmacist does not address consideration of dose reduction for use of [MEDICATION NAME] 50 mg. twice a day with a start date of 05/25/18 or 07/31/18. On 10/22/19, the APRN documents a GDR for [MEDICATION NAME] is contraindicated. The review of the psychiatric consultant report dated 07/10/19 notes the following findings: no depressed, no recent suicidal ideation, sleeping well, no side effects with [MEDICATION NAME] to [MEDICATION NAME] change and still with possible constipation and low back pain. The recommendation was to consider stopping [MEDICATION NAME] and monitoring for [MEDICAL CONDITION]. Subsequent visit, dated 08/14/19 notes R189 denied suicidal thoughts and stated he puts the cord around his neck to know which remote is which and to easily reach it. The recommendation was to continue to monitor for [MEDICAL CONDITION] and continue to work on polypharmacy. |
2020-09-01 |