| 6243 |
KINDRED TRANSITIONAL CARE & REHAB - LEWISTON |
135021 |
3315 8TH STREET |
LEWISTON |
ID |
83501 |
2010-08-27 |
309 |
D |
|
|
N5Z211 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined the facility failed to ensure each resident received the necessary care and services to attain and maintain the highest practicable physical well-being. This related to the facility's failure to ensure the Comprehensive Care Plan (CCP)included information on how to manage emergencies related to [MEDICAL TREATMENT] treatments. This was true for 1 of 2 sampled residents who received [MEDICAL TREATMENT] services (#12). In addition, the facility failed to ensure Physician's Orders were followed for the administration of antibiotics. This was true for 1 of 6 (#1) residents sampled for antibiotic therapy. Findings included: 1. Resident #12 was admitted to the facility on [DATE], and readmitted on [DATE], with [DIAGNOSES REDACTED]. The resident's Significant Change MDS assessment, dated 8/3/10, documented the following: * Modified independence for daily decision making * Special treatment [MEDICAL TREATMENT] * Monitoring acute medical condition The CCP, dated 12/10/09, stated in the problem section, "Fluid Imbalance: Risk for R/T (related to) [MEDICAL TREATMENT]". The "Approach" section stated Resident #12 had [MEDICAL TREATMENT] on Monday and Friday. Included in this section it documented staff were to monitor the shunt site for symptoms of infection and were not to take blood pressures on the shunt site arm. The instructions did not include any information on possible emergencies or complications related to [MEDICAL TREATMENT]. On 8/26/10 at 3:05 p.m., the DNS was informed that the care plan did not include any information on how to manage emergencies related to the shunt site such as bleeding. No further information was provided. 2. Resident #1 was initially admitted to the facility on [DATE], and readmitted on [DATE], with [DIAGNOSES REDACTED]. The resident's History and Physical, dated 1/21/10 and signed by the resident's physician, documented under the Impression section: "Diarrhea, acute. possible residual C.Difficile ([MEDICAL CONDITION]) possible Ulcerative [MEDICAL CONDITION]" The resident's most recent quarterly MDS assessment, dated 8/13/10, coded moderately impaired cognitive skills for daily decision-making, short-term memory problems, [DIAGNOSES REDACTED].e. monitoring acute medical condition. The resident's CCP Report, printed 8/23/10, identified the 3/4/10 problem of, "Infection: Potential for r/t hx of [MEDICAL CONDITION] (potential for infection related to a history of [MEDICAL CONDITION])." One of the problem approaches was, "Administer medications as ordered." The resident's 8/10 Physician's Orders (recapitulation) contained a 7/16/10 order for, "[MEDICATION NAME] 125 mg. po TID 'qod x 1 week ; --then--125 mg. po TID 'q 3rd day' x2 weeks; --then--125 mg. po BID (two times a day) 'q 3rd day' x3 weeks for [MEDICAL CONDITION]. Document on ABO Form. ([MEDICATION NAME] 125 milligrams by mouth three times a day every other day for one week --then--125 mg po TID 'every 3rd day' for 2 weeks; --then--125 mg po 2 times a day 'every 3rd day' for 3 weeks for [MEDICAL CONDITION]. Document the administration of [MEDICATION NAME] on the ABO form)." Elkin, Perry, and Potter, Nursing Interventions & Clinical Skills, 3rd edition, indicates on page 416, "...Right Documentation. After Administering a medication, the nurse records it immediately on the administration form..." The facility utilized an Antibiotic Charting form that contained handwritten entries of the Physician Orders in the first column under Antibiotic Name & Dosage Information and in the second column, the time of day for the administration. In addition, the form contained specific identified dates for the administration of the prescribed antibiotic. The resident's Physician's Orders, ABO charting forms, and local hospital Laboratory Outpatient Reports, from 3/10 through 8/10, were reviewed. The medication administrations that were of concern are identified below in examples a, b, c, & d. In each example, the local hospital Laboratory Outpatient Report is listed first, the specific Physician's Order second, and listed third, the ABO Charting form with the specific date and time of day when the medication administration records did not match the MD orders. a. 3/24/10, Laboratory Outpatient Report, Procedure C.Difficile, Result, "Positive for presence of C.Difficile toxin A and/or B..." The resident's 3/24/10 Physician Telephone Orders, signed by the physician, contained the order, "[MEDICATION NAME] 500 mg po TID x2 weeks dx: [MEDICAL CONDITION]." Note: The two weeks of this order were from 3/24/10 through 4/7/10. The resident's ABO Charting form, dated 3/24/10 through 4/7/10, identified an administration time of 2:00 p.m. However, the form did not provide evidence that the antibiotic [MEDICATION NAME] was administered on 4/6/10 at 2:00 p.m. b. 4/17/10, Laboratory Outpatient Report, Result, "Positive for presence of C.Difficile toxin A and/or B..." The resident's Physician signed a form entitled, "Note for (resident's name) on 4/20/10, "[MEDICATION NAME] 125 mg po TID for one week then BID for one week then stop and repeat stool for [DIAGNOSES REDACTED]icile after completing this course of [MEDICATION NAME]" Note: The second week for this order was from 4/28/10 through 5/4/10. The resident's ABO Charting form, dated 4/28/10 through 5/4/10, identified an administration time of 9:30 a.m. each day. However, the form did not provide evidence that the antibiotic was administered on 5/1/10 at 9:30 a.m. or on 5/2/10 at 9:30 a.m. c. 5/7/10, Laboratory Outpatient Report, Result, "Positive for presence of C.Difficile toxin A and/or B..." The resident's 5/9/10 Physician Telephone Orders, signed by the physician, contained the order, "Vanco(mycin) 125 mg po TID (no stop date)." The resident's 6/4/10 Physician Telephone Orders, signed by the physician, contained a new order, "(decrease) Vanco to 125 m(illigrams) po BID..." The resident's ABO Charting form, dated 6/5/10 through 6/18/10, identified the administration times of 8:00 a.m. and 8:00 p.m. each day. However, the form did not provide evidence that the antibiotic was administered on 6/14/10 at 8:00 a.m. or at 8:00 p.m. d. 7/15/10, Laboratory Outpatient Report, Result, "Positive for presence of C.Difficile toxin A and/or B..." The resident's Physician's Order was handwritten on a faxed copy of the 7/15/10 local hospital Laboratory Outpatient Report and signed by the Physician on 7/16/10. "[MEDICATION NAME] 125 m po TID qod ie every other day (no) med x 1 week (in example, for 1 week every other day, no medication) Then 125 m po TID q 3rd day for 2 wk Then 125 m po BID q 3rd day x3 wk." Note: The first week of this order was from 7/17/10 through 7/23/10. The next two weeks was from 7/24/10 through 8/7/10. The next three weeks was from 8/8/10 through 8/24/10. The resident's ABO Charting form, dated 7/17/10 through 7/23/10, identified the administration times of 8:00 a.m. and 1:00 p.m. However, the form did not provide evidence that the antibiotic was administered on 7/23/10 at 8:00 a.m. or at 1:00 p.m. The resident's ABO Charting form, dated 8/8/10 through 8/24/10, identified one administration time was 8:00 p.m. However, the form did not provide evidence that the antibiotic was administered on 8/22/10 at 8:00 p.m. On 8/24/10 at 9:00 a.m. during an interview, the resident stated that she had problems with a disease which she referred to as [MEDICAL CONDITION]'s disease (diarrhea). The resident was able to explain in detail how the disease process was recurrent throughout her entire life. She explained that she would have an episode, sometimes lose a lot of weight, be admitted to the hospital, get better, and go home. Then, months or years later, she would have another episode. On 8/26/10 at 2:00 p.m., the surveyor requested and the facility provided the laboratory reports from the resident's medical record, ABO Charting forms, and all Physician Orders related to the administration of antibiotics for the resident. The surveyor, the DON, and the RN Consultant reviewed the information as identified above. The DON and the RN Consultant agreed that the resident's ABO Charting forms did not contain consistent nursing staff initials for medication administration. On 8/27/10 at 8:45 a.m., the Administrator, DON, and RN Consultant were informed that the resident's medical record did not provide evidence that nursing staff administered the antibiotics as ordered by the resident's physician. No further information was provided. |
2014-04-01 |