cms_SC: 507

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.

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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
507 MUSC HEALTH CHESTER NURSING CENTER 425061 1 MEDICAL PARK DRIVE CHESTER SC 29706 2017-02-23 428 D 0 1 4GPQ11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility policy review and staff interviews the facility failed to demonstrate an adequate physician written response to pharmacist' medication regimen review (MRR) recommendations as evidenced by lack of documented clinical rationale for 3 out of 31 sampled Residents (R4, R17, and R37.) Findings include: 1. Review of the record for Resident (R4) revealed [DIAGNOSES REDACTED]. The MRR for R4 dated 6/27/16 revealed the Pharmacist wrote a recommendation for a gradual dose reduction (GDR) to decrease/discontinue both Seroquel 25 mg 1 tablet daily for psychosis since (MONTH) 2014 and Zoloft 25 mg daily for depression since (MONTH) 2014. The Physician responded, Disagree - No Changes. The date of physician entry was not recorded. Documentation of the physician clinical rationale was not found in the record. Review of the MRR for R4 dated 12/20/16 the Pharmacist wrote a recommendation for a GDR for both Sertraline 25 mg daily and Seroquel 25 mg daily documented: There are no reported behaviors documented at this time. Please consider if appropriate decreasing both medications to 1/2 tab daily or to lowest effective dose. The Physician responded: Agree to decreasing Seroquel to 12.5 mg daily however, failed to provide documented clinical rational for not agreeing to decrease Sertraline. The date of physician entry not recorded. 2. Resident (R17 was admitted from the hospital due to patient exhibiting bizarre behaviors at the assisted living facility. Record review revealed R17's list of [DIAGNOSES REDACTED]. R17's current list of medications included Seroquel 12.5 mg 1 tablet daily, and Celexa 10 mg 1 tablet daily. The MRR for R17 dated 6/12/16 revealed the Pharmacist wrote a recommendation to decrease both Seroquel 12.5 mg 1 tablet daily for psychosis since (MONTH) 2010 and Celexa 10 mg daily for depression since (MONTH) 2010. Physician responded, No Changes. The date of physician entry was not recorded. Documentation of the physician rationale could not be found in the record. An interview conducted with the Consulting Pharmacist on 2/21/17 at 3:12 p.m. who stated, the prescribing physician has been reminded more than once on the importance of documenting a clinical rationale when he/she disagrees with a pharmacy GDR recommendation. An interview conducted with the Medical Director on 2/22/17 at 2:19 p.m., who upon review of the GDR request forms signed by the prescribing physician who disagreed with the GDR recommendation with no clinical rationale documented, stated he would reeducate the physician to comply with the regulatory standard as written. 3. A review of physician's orders [REDACTED]. During a review of the Consultant Pharmacist's medication review for R37, a document entitled Note to Attending Physician/Prescriber indicated a pharmacist recommendation to reduce the anti-anxiety medication from .25 mg twice a day to .25 mg once a day. The physician had signed the note related to R37 but did not date when he signed it, wrote no change to the medication, but did not give a rationale for not following the pharmacist's recommendation. During an interview with the Registered Pharmacy Consultant, on 2/22/17 at 1:38 p.m., she stated she had spoken with the physician multiple times about R37 informing him he must document a rationale for not following her recommendations, but he continued to disregard her instructions. During an interview with the facility Medical Director on 2/22/17 at 2:20 p.m. a review of his response to pharmacy recommendations about R37's medications was discussed. He stated he was not aware of the necessity of documenting a rationale for not following a pharmacist recommendation to reduce a resident medication. The facility undated policy titled, Consultant Pharmacy Reports - Medication Monitoring and Management indicated: For Antipsychotics: If a resident is admitted on an antipsychotic medication or the facility initiates antipsychotic therapy, the facility must attempt a gradual dose reduction (GDR) in two separate quarters (with at least one month between the attempts) within the first year, unless clinically contraindicated. After the first year, a GDR must be attempted annually, unless clinically contraindicated. B. If a medication seems unnecessary or harmful to the resident, the (Director of Nursing, consultant pharmacist) requests the prescriber to evaluate the resident for the continued need for the medication and/or to consider tapering the medication. If the prescriber deems the medication necessary, a documented clinical rationale for the benefit of, or necessity for, the medication is documented in the resident's (active record). 2020-09-01