cms_MT: 4580
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4580 | MISSOURI RIVER CENTER | 275026 | 1130 17TH AVE S | GREAT FALLS | MT | 59405 | 2012-08-30 | 281 | E | 0 | 1 | M8XB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Resident #7 was admitted on [DATE] and readmitted on [DATE], with [DIAGNOSES REDACTED]. Review of the diet orders dated 7/20/12 and the physician's orders [REDACTED].#7 was to get large portions on plastic plates, his food textures were to be pureed, and fluid consistency was to be honey thick. At 5:15 p.m. on 8/27/2012, a meal tray was brought to the resident's room. The juice glasses contained juice and were not mixed to a honey fluid consistency. 5. Resident #15 was admitted on [DATE] and readmitted on [DATE], with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED]. Review of the Medical Nutrition Therapy assessment dated [DATE] stated that the resident had dysphagia and should receive house puree and honey liquids. During an interview at 6:00 p.m. on 8/27/2012, a family member discovered that a dietary person had given a non-pureed plate of food to her mother. The family member reminded the dietary staff that her mother had dysphagia and could choke on such a meal. At 4:00 p.m. on 8/28/12, an interview was conducted with the daughter of resident #15. She stated that on the weekend (8/25/12), she checked on her mother. Her mother was attending an activity. Her mother had received two cookies from an activities attendant and her mother was choking on them when she arrived. She also stated that her mother had received a plate of food for dinner on 8/27/12, which was not pureed, but was cut-up. Her mother was choking on the food again. She stated that her mother also received glasses of juice which were not honey thick in consistency. Based on observation, record review, resident and staff interviews, the facility failed to follow professional standards for physician orders? for 6 (#s 3, 4, 7, 15, 20, and 24) of 24 residents reviewed. Findings included: 1. Resident #3 was admitted to the facility on [DATE]; [DIAGNOSES REDACTED]. a. On 8/30/12 at 7:15 a.m., the surveyor reviewed the narcotic count book for resident #3. The surveyor noted the resident received his [MEDICATION NAME] on 8/16/12 and 8/21/12. The following physician order [REDACTED]. During review of the MAR for August 2012, the surveyor noted the 8/19/12 [MEDICATION NAME] dose was not signed as done by the nurse. At 7:20 a.m., staff member J, the 200-unit nurse, stated she was working on 8/21/12, when the wife discovered resident #3 did not have his [MEDICATION NAME] in place. Staff member J stated resident #3 went to a wound clinic appointment and his wife was there with him. The wound clinic staff and wife noticed the resident did not have his [MEDICATION NAME] in place. The wife came back to the facility and complained to the staff about the patch missing. Staff member J stated she applied the [MEDICATION NAME], when the resident came back from the wound clinic appointment. On 8/30/12 at 8:30 a.m., staff member K, the ADON, stated a new nurse was on the 200 unit on the night of 8/19/12. The new nurse told the facility she had missed the order on the MAR for the [MEDICATION NAME] to be replaced on 8/19/12 at 8:00 p.m. Staff member K stated as soon as the facility realized the [MEDICATION NAME] was missing the patch was applied to resident #3. The facility failed to follow the physician order [REDACTED].>b. On 8/30/12 at 1:05 p.m., during review of the Narcotic Book for resident #3, the surveyor noted the resident received his [MEDICATION NAME] on 6/5/12 at 5:00 p.m., 6/9/12 at 5:00 p.m., 6/12/12 at 6 p.m., and 6/22/12 at 6:00 p.m. The following physician order [REDACTED]. The facility chose the time of 8:00 p.m., for bedtime. The nurse on the 200 unit gave the [MEDICATION NAME] between 2 and 3 hours before the assigned time. On 8/30/12 at 1:20 p.m., staff member K stated the facility's policy on giving medications was 1 hour before and after the assigned time. 2. Resident #4 was admitted to the facility on [DATE]; [DIAGNOSES REDACTED]. On 7/24/12 the following physician order [REDACTED]. On 8/30/12 at 8:30 a.m., during the review of the MAR for August 2012, the surveyor noted the 8/4 and 8/16/12 cleansing and dressing change to the right hip was not signed as done by the nurse. On 8/30/12 at 11:30 a.m., staff member F, unit manager, reviewed the medical record and stated she was unable to find why the dressing was not done on 8/4 and 8/16/12. 3. Resident #20 was admitted to the facility on [DATE]; [DIAGNOSES REDACTED]. The following treatment order was on the August 2012 MAR, [MEDICATION NAME] to sacrum daily and when soiled (per wound clinic) - Evening Shift Everyday. On 8/30/12 at 8:40 p.m., during the review of the MAR for August 2012, the surveyor noted the 8/29/12 treatment was not signed as done by the nurse. By the end of the survey on 8/30/12, the facility had not provided the surveyor with information of why the treatment was not done. 6. Resident #24 was admitted to the facility on [DATE]; [DIAGNOSES REDACTED]. On 8/28/12 at 2:30 p.m., the resident was interviewed. The resident stated when she was first admitted to the facility, there was an incident in which she had not had her wound dressing changed for 5 days, although the physician order [REDACTED]. Based on the admission physician's orders [REDACTED]. Review of the medical record revealed the resident's dressing was changed on 6/28/12 and then again on 7/3/12, for a total of 5 days between dressing changes. On 8/29/12 at 1:30 p.m., the ADON reviewed the medical record and stated she was unable to locate information indicating the resident's wound dressing had been changed between 6/29/12 and 7/2/12. ?As stated in Fundamentals of Nursing by Sue DeLaune and Patricia Ladner, the following was noted: In accord with their nursing practice act, nurses are obligated to follow the orders of a licensed physician or other designated health care provider unless the orders would result in client harm. The nurse has a legal responsibility to the client to ensure that the order is clear and appropriate to the client's treatment. When the nurse queries a physician order, the physician should be contacted to obtain clarification. ?Standards for nursing practice for administration of medication provide, in pertinent part that: Medications must be accurately administered and documented. Accurate administration includes transcribing the drug order correctly, delivering the correct drug, to the correct resident, by the correct route, in the correct dose. Accurate documentation involves recording information on the drug administered, including the client's response to the medication. See generally: Lippincott, Nursing Drug Guide, 1998 (Lippincott) and Perry & Potter, Clinical Nursing Skills & Techniques; 1998, (Perry & Potter). | 2015-12-01 |