cms_SC: 10079
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10079 | LILA DOYLE AT OCONEE MEDICAL CENTER | 425075 | 101 LILA DOYLE DRIVE | SENECA | SC | 29672 | 2010-08-18 | 431 | E | 0 | 1 | SNPY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, interviews, and review of the facility provided policies for Oral Medication Administration, Controlled Medications (both policies undated) and Event Reporting (last reviewed 7/10), the facility failed to maintain records of receipt and disposition of all controlled drugs in sufficient detail to ensure a determination that drug records were accurate and periodically reconciled for 3 of 7 sampled residents reviewed for the administration of controlled substances. Resident # 4 received an incorrect dose (less than what was ordered) of a controlled medication. The medical record documented the medication was administered, but not removed from the controlled supply. Concerns were identified related to the reconciliation of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Resident # 17 was documented as having received a medication which was not documented as removed from the controlled supply. In addition the facility failed to provide a separately locked, permanently affixed compartment for storage of discontinued controlled drugs (Schedule II and other drugs subject to abuse) which limited access to authorized personnel, in the First Floor Medication Room. (One of 2 medication rooms reviewed for medication storage). The findings included: On 8/18/10 at 8:53 AM, observation of the First Floor Medication Room revealed a locked cabinet used for storage of discontinued narcotics and other controlled medications (per the Consultant Pharmacist). The cabinet was locked but a hole was observed in the cabinet door. The hole was measured to be 20 inches from the bottom of the cabinet. The hole was large enough for this surveyor to insert a hand through the hole and inside the locked cabinet. Observation of the contents of the cabinet revealed the following multidose containers: 1 pack OxyContin CR (Controlled Release) 10 mg - 4 tablets remaining 1 pack Morphine ER (Extended Release) 15 mg - 4 tablets remaining 1 pack Temazepam 30 mg Capsules - 2 capsules remaining 1 pack Diazepam 5 mg Tablets - 30 tablets 1 pack Ambien 10 mg Tablets - 9 tablets remaining 1 pack Ambien 10 mg Tablets - 28 tablets remaining 1 pack Lortab 5/500 mg Tablets - 70 tablets remaining 1 pack Roxicet 5/325 mg Tablets - 50 tablets remaining. In addition to those listed above, there were 45 other (partial and full) containers of controlled medications stored in the cabinet. During an interview on 8/18/10 at 8:58 AM, the Consultant Pharmacist verified that the hole in the cabinet door was a possible means of access to the discontinued controlled medications by unauthorized personnel and that the discontinued controlled medications were in containers that would fit through the hole in the cabinet door. The facility last admitted Resident # 4 on 7/9/10. The resident's [DIAGNOSES REDACTED]. On 8/17/10 at 10:15AM, review of the current medical record revealed the resident was ordered by the physician to receive liquid Lortab 7.5/15 milliliters (ml)- 20 ml every four hours for pain. A review of the Narcotic Sign Out Record revealed on 7/28/10 at 1800 15 ml was signed out as administered with a notation of "bottle completed". The Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Review of the physician orders, physician progress notes [REDACTED]. After the concern had been brought to the attention of the facility, the nurse responsible for the administration of the medication was sent to speak to this surveyor, accompanied by the Director of Nursing and the Consulting Pharmacist. The nurse stated s/he was aware that the full dose had not been administered. S/he stated it had brought it to the attention of the supervisor, and s/he had reassessed the resident. S/he stated 15 ml had been administered because that was all that was left in the bottle and an additional supply was not available at that time. When asked if s/he understood the surveyors concerns and that there was no documentation in the medical record, s/he stated "yes." The facility last admitted Resident # 17 on 8/14/10. The resident's [DIAGNOSES REDACTED]. On 8/18/10 at 9:20AM record review revealed the resident was ordered by the physician to receive Ativan .5 milligrams daily at 2PM. Review of the July 2010 Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Review of the Narcotic Sign out Record indicated the medication was not removed from the controlled supply on 7/23 and 7/26/10. On 10:10AM, the Unit Manager stated the initial in the box for 7/23 and 7/26/10 was an "R" meaning that the medication was refused. The Unit Manager verified the initial was not circled and there was no further documentation on the back of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED] On 7/6/10 Ativan 0.5 milligrams was documented as administered to Resident # 17 at 1400. However, the Narcotic Sign out record did not document the medication was removed for administration and the quantity of medication remained the same from 7/5-7/7/10. On 8/18/10 at 9:20AM record review revealed the resident was ordered by the physician to receive Ativan .5 milligrams daily at 2PM. Review of the August 2010 Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]'s refusal. The Ativan quantity available for administration on the narcotic sign out record remained the same from 8/7 (28 doses) to 8/12/10 (27 doses) . On 8/18/10 at 10:10AM the Unit Manager stated s/he was unable to find additional information to explain the doses which were not administered. A review of the facility provided policies revealed under Event Reporting that the "following medication incidents should be reported; Any error or omission in providing a medication such as: 1. Per physician's written order 2. At the time and date prescribed 3. With the correct drug 4. In the correct quantity...." The facility policy for Controlled Medications stated...: "2. A declining inventory record is to be maintained for all controlled drugs. This "Narcotic Sign Out Record" is to account for each dose of medication given to a resident. Each line of the Narcotic Sign Out Record is to represent one dose.... 5. If a dose is removed from the container for administration but refused by the resident or not given for any reason, it is to be documented on the Narcotic Sign out record on the line representing that dose. The controlled medication should be placed in a small envelope that is stamped with the resident's name, prescription number, and name of controlled medication. This medication is to be given to the supervisor or DON (Director of Nursing) for proper destruction by the pharmacist. If unable to follow above procedure, two nurses may flush refused dose in the sewer system with appropriate documentation on the Narcotic Sign Out Record. 7. Any discrepancy in the count of controlled substances is to be reported immediately to the responsible supervisor and a signed entry shall be recorded on the page where the discrepancy is found...." The facility policy for Oral Medication Administration Procedure stated: "14. If a resident refuses medication, indicate on MAR by placing the letter "R". a. Note refusal or ingestion of less than 100% of dose in the "Nurse's Medication Notes" on the back of the MAR." The facility admitted Resident #19 on 5/10/2006 with [DIAGNOSES REDACTED]. During review of the resident's medical chart on 8/17/2010 and 8/18/2010, records revealed multiple entries, for the month of July, on the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. No witnesses were documented. Resident #19 received Xanax 0.25 milligrams (mg) 1 tablet twice a day at 0900 (9:00 AM) and 1700 (5:00 PM). She/he also received Lortab 2.5/500 tablet 1-twice a day at 9:00 AM and 5:00 PM. There were also entries that indicated the medications were given on the MAR but were not signed out on the Narcotic Record. Xanax 0.25 mg tablets were signed out on the resident's Narcotic Record on 7/5 at 0900 and 7/14 at 0900, 7/25 at 0900. The MAR indicated [REDACTED]. Each entry stated that the resident had refused the medication with no second nurses' signature to witness the wasted narcotic. On 7/24 and 7/27/2010 the Xanax 0.25 mg tablet was signed as given on the MAR but was not signed on the Narcotic record as being removed from the supply. Resident #19 also received Lortab 2.5/500 at 9:00 AM and 5:00 PM. On 7/13, 7/14 at 9:00 AM, 7/23 at 5:00 PM, 7/25 at 9:00 AM , 7/28 at 9:00 AM and 7/30/2010 at 5:00 PM the Lortab was signed as removed from the narcotic supply to administer. The MAR indicated [REDACTED]. The records indicated that there had not been an additional nurses' signature verifying that the medications had been wasted properly. Review of Resident #19's Nurses' Notes revealed one entry on 7/25/10 that the resident had refused her/his medications. This entry contained no information related to a witness to the disposal of the controlled medications. On 8/18/2010 at 10:30 AM, during an interview with Registered Nurse #1, she/he verified that there had been no witnesses to the disposal of the Xanax and the Lortab documented. She/he also agreed that there should be two nurses that witness the disposal of any controlled medication. Cross refer to F281 related to facility policies for Medication Administration, Controlled Medications and Event Reporting. | 2014-06-01 |