cms_NE: 9296
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9296 | ALPINE VILLAGE RETIREMENT CENTER | 285190 | 706 JAMES STREET | VERDIGRE | NE | 68783 | 2013-03-28 | 329 | E | 0 | 1 | UVQR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Licensure Reference Number 175 NAC 12-006.09D Based on record review and staff interview; the facility failed to assure 3 residents (Residents 2, 3 and 24) were free from the use of unnecessary drugs. Psychoactive medications (medications that act primarily on the central nervous system to alter brain function, resulting in temporary changes in perception, mood and behavior) were used without adequate indication for use and /or documentation to support dosages used above daily recommendations. In addition, gradual dose reductions (GDR) were not attempted and there was no documentation to indicate why GDR were clinically contraindicated. Sample size was 33 and facility census was 46. Findings are: A. A review of Resident 2's Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning) dated 1/9/13 revealed [DIAGNOSES REDACTED]. The MDS further indicated Resident 2 exhibited no behaviors. Review of Physician Admission/Monthly Orders dated 7/30/12 indicated an order for [REDACTED]. Review of Behavior Summary reports from 12/1/12 through 3/26/13 revealed the resident displayed no adverse behaviors. Review of the Chronological Record of Medication Regimen Review for Resident 2 revealed on 1/9/13 the Consultant Pharmacist recommended a GDR of the [MEDICATION NAME]. There was no documentation in the medical record to indicate a GDR of [MEDICATION NAME] had been attempted. There was no documentation to indicate why a GDR was clinically contraindicated. During an interview on 3/27/13 from 9:20 AM to 9:35 AM, Nursing Assistant (NA)-M verified adverse behaviors were not exhibited by Resident 2. During an interview on 3/27/13 from 10:00 AM to 10:11 AM the Director of Nursing (DON) confirmed the Consultant Pharmacist had recommended a GDR of the [MEDICATION NAME] for Resident 2 and no GDR had been attempted. Furthermore the DON verified adverse behaviors were not exhibited by Resident 2. B. Review of Resident 3's MDS dated [DATE] revealed the resident was admitted to the facility on [DATE] with diagnoses of hypertension, diabetes mellitus, [MEDICAL CONDITIONS], dementia, [MEDICAL CONDITION] and depression. The same MDS indicated the resident rejected cares on 1 to 3 days during the 7 day assessment period, and that no other behaviors were exhibited by the resident. physician's orders [REDACTED]. Review of a Medication Review form dated 5/7/09 revealed a request for a GDR of Resident 3's [MEDICATION NAME] 0.25mg daily. Documentation indicated No reduction attempted since admission. and nursing staff comments revealed No behavioral problems noted by nursing at this time. The physician declined the GDR. There was no documentation to indicate why a GDR was clinically contraindicated. Review of a Medication Review form dated 9/16/09 revealed a request for a GDR of Resident 3's [MEDICATION NAME] 0.25mg daily. Nursing staff comments revealed Yearly documentation or reduction attempt is needed .No problems noted at this time by staff. The physician declined the GDR and indicated a previous dose reduction had failed, the current doseage was required to maintain baseline functions, and a further dose reduction was clinically contraindicated. However, there was no evidence to indicate a GDR had been attempted. Review of a Medication Review form dated 8/9/10 revealed the physician agreed to discontinue a prn (as needed) order for [MEDICATION NAME] 0.25mg as requested by the Consultant Pharmacist as the prn [MEDICATION NAME] had not been used in greater than 3 months. However, the physician declined a GDR of the resident's routine dose of [MEDICATION NAME] 0.25mg daily, indicating a previous dose reduction had failed, the current doseage was required to maintain baseline functions, and a further dose reduction was clinically contraindicated. However, there was no evidence to indicate a GDR had been attempted. Review of a Medication Review form dated 7/8/11 revealed a request for a GDR of Resident 3's [MEDICATION NAME] 0.25mg daily. The physician declined the GDR and indicated a previous dose reduction had failed, the current doseage was required to maintain baseline functions, and a further dose reduction was clinically contraindicated. However, there was no evidence to indicate a GDR had been attempted. Review of a Medication Review form dated 6/8/12 addressed Resident 3's orders for [MEDICATION NAME] (an anxiety relieving medication) 0.5mg daily and BID (twice daily) prn, [MEDICATION NAME] 0.25mg daily, and [MEDICATION NAME] (an antidepressant medication) 25mg daily. The Consultant Pharmacist requested the physician consider a trial discontinuation of 1 of these medications as no behavior problems noted in quite sometime. Although the physician discontinued the routine dose of [MEDICATION NAME], no other changes were made, and Resident 3 continued to receive [MEDICATION NAME] 0.25mg daily. Review of Progress Notes dated 11/1/12 through 3/27/13 revealed 2 instances of documentation related to Resident 3's behaviors: 11/5/12 - staff attempting to feed Resident 3 and the resident indicated didn't want any of that (expletive). 3/4/13 at 1:11 PM - resident more difficult to feed at breakfast and dinner as constantly talking about dog and sister. Review of the Behavior Summary Reports dated 2/1/13 through 3/26/13 revealed Resident 3 rejected cares 3 times on the day shift and 2 times on the evening shift, and had yelling/screaming behaviors 2 times on the day shift. There was no documentation to indicate any other behaviors were demonstrated. During interview on 3/27/13 at 2:30 PM the Director of Nursing (DON) verified a GDR of [MEDICATION NAME] was never attempted for Resident 3. C. Review of Resident 24's MDS dated [DATE] revealed diagnoses of dementia, anxiety disorder and depression. The MDS indicated the resident had hallucinations and delusions. Review of Resident 24's MDS dated [DATE] also revealed the resident had hallucinations and delusions. The same MDS further indicated the resident displayed adverse physical and verbal behaviors and rejected care 1 to 3 days per week. Review of a facsimile (fax) dated 6/15/12 revealed Resident 24's physician was notified regarding the resident's increased behaviors of yelling, fear of fire and restlessness. The fax indicated the resident's [MEDICATION NAME] had been discontinued on 6/1/12. The physician gave orders to restart .5 mg of [MEDICATION NAME] 2 times daily. Review of a fax dated 7/9/12 indicated Resident 24's behaviors of yelling and being disruptive were increasing. The physician gave orders to start [MEDICATION NAME] (another type of medication used to treat psychotic symptoms) 50 mg twice daily (and in addition to the previously ordered dose of [MEDICATION NAME]). Review of a Nursing Home Progress Note by the physician on 8/7/12 at 1:00 PM revealed the resident was having severe dementia issues with hallucinations. The physician increased Resident 24's [MEDICATION NAME] to 2 mg twice daily which was 4 times the previous daily dose. The physician also increased the [MEDICATION NAME] to 100 mg 3 times daily which was 3 times the previous dose. (According to Transmittal 274 Appendix PP-Guidance to Surveyors, the recommended daily dose threshold for [MEDICATION NAME] should not exceed 150 mg daily. Resident 24's [MEDICATION NAME] dose was 2 times above the recommended dosage.) Review of Resident 24's MAR indicated [REDACTED]. There was no documentation in the medical record to indicate a GDR of [MEDICATION NAME] or [MEDICATION NAME] had been attempted. There was no documentation to indicate why a GDR was clinically contraindicated or why Resident 24 continued to receive [MEDICATION NAME] above the recommended dosage. The DON confirmed during interview on 3/27/13 from 1:05 PM until 1:10 PM that Resident 24's physician had not ordered a GDR of [MEDICATION NAME] and [MEDICATION NAME] since the dosages were increased on 8/7/12. | 2016-09-01 |