| 58 |
BELLA TERRA OF BILLINGS |
275020 |
1807 24TH ST W |
BILLINGS |
MT |
59102 |
2016-12-15 |
329 |
E |
0 |
1 |
PSRD11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and observation, the facility failed to complete gradual dose reductions for residents on either antipsychotic or hypnotic medications for 3 (#s 1, 12, and 15) of 19 sampled residents. The findings include 1. Resident #1 had a psychiatric [DIAGNOSES REDACTED]. Review of resident #1's Medication Administration Record, dated (MONTH) (YEAR), showed resident #1 was receiving [MEDICATION NAME] 7.5 mg Tablet Oral, each day, starting 11/12/15. The orders showed to take the medication before dinner, at 1600, for [MEDICAL CONDITION]. She also had on order for 7.5 mg of [MEDICATION NAME], as needed every eight hours, starting 9/25/16, for acute agitation. Review of resident #1's medical record showed a lack of evidence for a gradual dose reduction for the [MEDICATION NAME] scheduled dose of 7.5 mg. During an interview on 12/13/16 at 3:03, staff member D stated resident #1's family did not allow the GDR's to be completed. She stated the resident's family member wanted the resident on the [MEDICATION NAME]. During an interview on 12/14/16 at 09:00 a.m., resident #1's family member stated they were unaware of what a GDR was, or why the facility should complete a GDR on medications. The family member stated they did not participate in the care plan meetings, so they were unaware if the facility had discussed a reduction of the scheduled dose of [MEDICATION NAME]. The family member stated that during the next appointment resident #1 had with the psychiatrist, they would ask about having the dose reviewed for the [MEDICATION NAME]. During an interview on 12/13/16 at 05:00 p.m., NFS 2 stated [MEDICATION NAME] was not ideal for the geriatric population. He stated he wrote to the psychiatrist asking for a GDR to be completed on the scheduled dose of [MEDICATION NAME], but he did not receive a response from the psychiatrist. He stated he also asked for a more definitive [DIAGNOSES REDACTED]. He also stated that he sent a letter to the psychiatrist in regards to resident #1's weight loss, asking for a review of the medications, and the psychiatrist failed to respond to that communication as well. 2. Resident #15 had a [DIAGNOSES REDACTED]. Review of resident #15's Quarterly MDS, section N0410, section D, dated 10/17/16, showed the resident had received a hypnotic medication 6 out of the 7 day look back period. Review of resident #15's MAR, dated (MONTH) (YEAR), showed [MEDICATION NAME] 5 mg, as needed, for [MEDICAL CONDITION], to be given at night. The order date was 4/26/16. The MAR showed the [MEDICATION NAME] had been given 12/1, 12/2, 12/3, 12/4, 12/5, 12/6, 12/7, 12/9, 12/10, 12/12, 12/13, and 12/14/16. Review of resident #15's medical record showed a lack of evidence for a gradual dose reduction for the [MEDICATION NAME] 5 mg, ordered 4/26/16. Review of resident #15's Chronological Record of Medication Regimen Review, reviewed by the pharmacist on 5/28/16, 6/25/16, 7/24/16, 8/27/16, 9/25/16, 10/29/16, and 11/27/16, showed a lack of evidence relating to a reduction or information on a reduction, for the [MEDICATION NAME]. During an interview on 12/14/16 at 2:15 p.m., staff member Y was unable to locate a GDR in the resident's medical records. Staff member Y stated a GDR probably was not completed for the [MEDICATION NAME] because the resident would never be taken off that particular medication due to her difficulty sleeping. During an interview on 12/14/16 at 4:30 p.m., staff member D stated the order was hand written for the medication, written in April, but there was no other paperwork in the resident's record for a GDR for the medication. Staff member D stated she consulted with NFS 2, and he was unable to find any paperwork related to a GDR or any other medication review for the [MEDICATION NAME]. 3. Resident #12 was admitted to the facility with [DIAGNOSES REDACTED]. A review of the resident's Quarterly MDS, with an ARD of 11/15/16, showed the resident was cognitively intact, with a BIMS of 14. A review of resident #12's Physician Recapitulation Order, dated 12/12/16, showed the resident was on [MEDICATION NAME] 5 mg tablet, at the hour of sleep, for anxiety disorder, unspecified, which started on 6/28/16. A second order for [MEDICATION NAME] showed, [MEDICATION NAME] 5 mg tablet, as needed, every eight hours, for PRN anxiety, which started on 11/11/16. A review of resident #12's MAR, dated (MONTH) (YEAR), showed: [MEDICATION NAME] 5 mg tablet, at hour of sleep, starting on 6/28/16. The medication was given for anxiety disorder, unspecified, which was discontinued on 12/5/16. The order was changed to [MEDICATION NAME] 5 mg tablet, twice daily. The new order did not give a rationale for use. A second order on the resident's MAR for (MONTH) (YEAR), for [MEDICATION NAME], showed: [MEDICATION NAME] 5 mg tablet, as needed, every eight hours, starting 11/11/15, and discontinued on 12/5/16. There was no documented rationale for use of PRN anxiety medication. A review of resident #12's MAR, from (MONTH) (YEAR) to (MONTH) (YEAR), showed, [MEDICATION NAME] 5 mg tablet, at hour of sleep, starting 6/28/16, for anxiety disorder, unspecified. A second order on the resident's MAR's for (MONTH) through (MONTH) (YEAR), showed an order for [REDACTED]. A review of resident #12's physician progress notes [REDACTED]. Continue [MEDICATION NAME] 20 mg three times a day and 40 mg at bedtime. Continue [MEDICATION NAME] therapy. Medications listed on the Outpatient Encounter Prescriptions, as of 7/26/16, showed: [MEDICATION NAME] 5 mg tablet, take one tablet by mouth every eight hours as needed for Muscle Spasms. The indication noted in the progress note was not consistent for the use indicated in the resident's MAR and Physician Recapitulation Orders. A review of resident #12's physician progress notes [REDACTED]. A review of resident #12's physician progress notes [REDACTED]. [MEDICATION NAME] started last month. Change [MEDICATION NAME] to 5 mg BID and start [MEDICATION NAME] 0.5 mg by mouth every 6 hours as needed for anxiety. A review of resident #12's Monthly Drug Regimen Review, showed on 11/17/15, [MEDICATION NAME] 5 mg at bedtime as needed for anxiety. The Monthly Drug Regimen Review failed to show any further monthly reviews for [MEDICATION NAME]. A review of the facility's Gradual Dose Reduction Log, failed to show a gradual dose reduction was completed for resident #12 for the use of [MEDICATION NAME], dating back to 11/11/15. During an interview on 12/14/16 at 4:00 p.m., resident #12 stated she had felt the need for an increase in her [MEDICATION NAME] due to her anxiety, and due to her increased feelings of anxiety from the progression of her [MEDICAL CONDITION]. Resident #12 could not recall using the medication for muscle [DIAGNOSES REDACTED], but did mention she did take a medication for that as well. During an interview on 12/15/16 at 8:30 a.m., staff member D stated the gradual dose reductions needed to be completed at regular intervals as provided by the CMS regulation. Staff member D stated she was aware the gradual dose reductions had not been completed for resident #12's [MEDICATION NAME] dosing. During an interview on 12/15/16 at 9:33 a.m., NF1 stated she did get notifications from the pharmacist regarding the resident's gradual dose reductions. NF1 stated she recalled increasing resident #12's [MEDICATION NAME] due to muscle spasms, but did not recall completing any gradual dose reductions for resident #12. During an interview on 12/20/16 at 10:00 a.m., NF2 stated he had not completed a gradual dose reduction on resident #12, due to the medication being used for muscle spasms. NF2 stated he completed the monthly medication reviews for the residents, and when the quarterly reviews were due for [MEDICAL CONDITION] and hypnotic medications he would complete the gradual dose reductions, and notified the providers. NF2 stated he remembered the regulations showed if the resident was on a medication, which was exempt from needing a gradual dose reduction, he did not need to complete a GDR. A review of the [MEDICAL CONDITION] Medication policy showed: - 1. The facility will make every effort to comply with state and federal regulation related to the use of psychopharmacological medications in the long term care facility to include regular review for continued need, appropriate dosage, side effects, risk and or benefits . - 5. Efforts to reduce dosage or discontinuation of psychopharmacological medications will be ongoing, as appropriate, for clinical situations. A request was made on 12/15/16 at 7:40 a.m., for the gradual dose reduction policy. The facility stated there was no such policy, and they followed the federal guidelines on the completion of gradual dose reductions. |
2020-09-01 |