cms_NE: 459

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

This data as json, copyable

rowid facility_name facility_id address city state zip inspection_date deficiency_tag scope_severity complaint standard eventid inspection_text filedate
459 HILLCREST NURSING HOME 285080 P O BOX 1087, 309 WEST 7TH STREET MCCOOK NE 69001 2018-01-24 760 G 1 0 6LD811 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number: 175 NAC 12-006.10D Based on record reviews and interviews, the facility failed to transcribe a medication order for a diuretic medication (medication to reduce swelling) for one sampled resident (Resident 4). The failure resulted in a 14 day delay in the medication being provided to the resident and resulted in the resident's continued leg swelling and development of blisters. Sample size was four current residents. Facility census was 77. Findings are: Record review of Resident 4's Face Sheet printed on 1/24/18 revealed the resident was admitted to the facility on [DATE]. Among the medical [DIAGNOSES REDACTED]. Record review of Resident 4's electronic medical record and chart revealed the following: - from the Departmental Notes an entry dated 12/15/17 at 4:37 p.m. revealed the resident was seen and received new orders from the physician. - A Message from Organization: (name of clinic). New Medication (a web-based communication tool with communication from the clinic to the facility) dated 12/15/17 and generated on 12/16/17 revealed the physician also started (Resident 4) on 20 mg (milligrams) of [MEDICATION NAME] PO (by mouth) daily. An Electronic Prescription via Sure Scripts form from the clinic to the pharmacy revealed an order dated 12/15/17 for Resident 4 was written for [MEDICATION NAME] 20 mg oral tab with instructions to administer 1 (one) Tablet by mouth once daily. - 12/23/17 at 3:34 p.m. from the Departmental Notes the resident was assessed with [REDACTED]. 2+ indicated indention of the skin 2-4 millimeters deep which does not rebound for 10-15 seconds when pushed inward) to BLLE (bilateral lower extremities) . - A Nursing Communication form sent to the physician on a follow up visit dated 12/29/17 revealed the resident was being seen in Follow-up and requested the physician Please look @ (at) red, raised open areas to L (left) lower leg . The physician provided a communication note from the visit which read: See web message from 12/15/17. Patient (Resident 4) should be on [MEDICATION NAME] (Generic name for [MEDICATION NAME]) 20 mg by mouth once daily. - Departmental Notes entry dated 12/29/17 at 5:30 p.m. recorded the resident had an appointment with the physician. Orders are as follows. See web message from 12.15.17. Patient (Resident 4) should be on [MEDICATION NAME] 20 mg by mouth once daily . - e-Medication Administration Record [REDACTED]. - Departmental Notes entry dated 1/18/18 at 12:12 p.m. revealed an entry by the Registered Dietitian which read: Current weight 215# (215 pounds). Admit weight was 195# in October. Dr reviewed weight of 214# with no dietary changes last month . [MEDICATION NAME] was added last month and increased this month, so we may see some weight fluctuations due to [MEDICAL CONDITION] changes . Record review of a facility Investigation Report dated 1/16/18, forwarded to the State Agency, revealed the facility investigated the delay in the order implementation for Resident 4's [MEDICATION NAME]. The investigation was initiated after Resident 4's spouse reported to the MDS (Minimum Data Set, a federally mandated comprehensive assessment tool utilized to develop resident care plans) Coordinator on 1/9/18 that Resident 4's [MEDICATION NAME] order was missed by the nursing staff when ordered on [DATE] and not started until 12/29/17. The spouse reported the resident's legs had some increased [MEDICAL CONDITION] with blisters to the lower extremities due to the resident not receiving [MEDICATION NAME]. The report acknowledged the error in getting the medication order transcribed and administering the medication to the resident. The Potential Causal factors revealed the physician sent the order over the Portal (the electronic computerized communication system between clinic and facility) and that the order had not been opened by the nurse on duty. The facility determined that once an order is opened on the portal per facility protocol, it is to be entered into the computer, if it is opened staff have no way to know it is a new order and has not been entered into the computer. The investigation Outcome revealed the order for [MEDICATION NAME] was missed on the Portal and the resident had not received (the resident's) [MEDICATION NAME] for 13 days. The report revealed It was noted by the Primary care Physician that there was increased swelling with small pinpoint blisters to lower extremities (for Resident 4) bilaterally. Primary Care Physician felt this increased swelling and blisters were caused by resident not receiving (the resident's) [MEDICATION NAME]. Interview with the ADON (Assistant Director of Nursing) and MDS Coordinator on 1/24/18 9:45 a.m. confirmed Resident 4 received a physician's orders [REDACTED]. Due to a problem with the computerized communication portal, the order was not transcribed and the medication was not started until after the physician alerted the facility to the mistake on 12/29/17. The ADON confirmed the facility investigated the issue and verified the omission of the original order resulted in the resident experiencing increased swelling and blisters. 2020-09-01