| 8296 |
AGAPE REHABILITATION OF CONWAY |
425391 |
2320 HIGHWAY 378 |
CONWAY |
SC |
29527 |
2012-05-02 |
157 |
K |
0 |
1 |
YK4D11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification, Extended, and Complaint Surveys, based on record review, interviews, and review of the facility's policy entitled Condition Change, the facility failed to notify the attending physician in a timely manner of changes in residents' physical conditions, which required intervention/changes in treatment. The physician was not notified of the onset of gastrointestinal signs and symptoms of [MEDICAL CONDITIONS] in a timely manner for four of nine sampled residents reviewed with [MEDICAL CONDITION]. Three of these four developed symptoms after admission to the facility. This failure to notify the physician in a timely manner resulted in significant delays in treatment and potential for transmission of infection. (Resident # 1, 4, 8 and 12) The findings included: The facility admitted Resident #1 on 8/26/11 following hospitalization for Altered Mental Status. She was discharged with [DIAGNOSES REDACTED]. The hospital discharge summary noted that she had been treated with [MEDICATION NAME], which had been changed to [MEDICATION NAME] to continue at the nursing facility until 9-2-11. Review of Physician Telephone Orders with the Assistant Director of Nurses (ADON) on 5-1-12 at 10:20 AM revealed that on 8-27-11, the physician ordered intravenous fluids for dehydration. On 8-29-11, the resident was started on [MEDICATION NAME] IM (intramuscular) for 3 days for signs and symptoms of a UTI. Review of the Daily Skilled Nurse's Notes with the ADON revealed that on 9/8/11, the resident had a watery, foul smelling stool. The physician was notified and ordered a stool specimen to check for [MEDICAL CONDITION]. On 9/9/11, the facility was notified of a positive result and the physician ordered treatment with [MEDICATION NAME] for 10 days and isolation precautions. [MEDICATION NAME] was completed on 9-19-11. Review of the computerized Activities of Daily Living (ADL) Records on 5-1-12 at 11 AM with Certified Nursing Assistant (CNA) #1 and the ADON revealed that the resident began having 1 to 2 loose stools daily (when bowel movements were documented) on 8-28-11, at times having an odor. Multiple entries had no consistency noted. There was no evidence that the physician was notified until 9-8-11 when the nurse in the Daily Skilled Nurse ' s Notes made the first notation. Following completion of the [MEDICATION NAME] on 9-19-11, review of the Daily Skilled Nurse's Notes and the computerized bowel movement (BM) records revealed that the resident had no further symptoms until 9-24-11 when she experienced four diarrhea stools per the CNA documentation and diarrhea off + on by the nurse. The Physician Extender saw the resident on that date, but the Progress Note indicated that the resident was seen for altered mental status .preceded by weakness and dark urine. There was no mention of current diarrhea/loose stools and no immediate interventions. The document erroneously listed [MEDICATION NAME] as an active medication starting 9-19-11. There was no evidence that the physician was notified of the recurrence of diarrhea until two days later when a 9-26-11 Physician's Telephone Order was written to Recheck stool for [MEDICAL CONDITION]. The 9-26-11 Progress Note again listed [MEDICATION NAME] as an active medication starting 9-19-11. On 9-28-11, the [MEDICAL CONDITION] toxin was reported as positive and the physician ordered treatment with [MEDICATION NAME] for ten days. During an interview on 5-1-12 beginning at 10:15 AM, the ADON reviewed the medical record and confirmed the above information. She stated that precautions were implemented when the physician gave the order. She further stated that the physician should have been notified and precautions implemented at the onset of symptoms. She was unable to explain why this had not been done. Resident #4 with [DIAGNOSES REDACTED]. Review of the hospital Discharge Summary with the ADON on 5-1-12 at 6 PM revealed that the resident had been treated for [REDACTED]. She was discharged to the facility with a [MEDICATION NAME] treatment to the lower leg. Review of the Daily Skilled Nurse's Notes revealed that on 12/19/11, the resident experienced a large amount of diarrhea stool with mucous. The physician was notified on 12-19-11 and an order received for Stool for [MEDICAL CONDITION] ASAP (to rule out). Dx (Diagnosis) possible [MEDICAL CONDITION]. A laboratory report dated 12/22/11 showed the resident tested positive for [MEDICAL CONDITION]. Five days later, on 12/27/11, the physician/extender saw the resident, ordered [MEDICATION NAME] starting on 12-28-11 to treat the [MEDICAL CONDITION], and ordered contact isolation. The physician gave an interim Telephone Order on 12-23-11 for Preparation H .apply TID (three times daily) to rectal region, indicating that the resident was suffering from swollen, irritated hemorrhoids. On 12-25-11, the physician/extender wrote to decrease [MEDICATION NAME] from twice daily to be given an as needed basis. Review of the computerized ADL Records on 5-1-12 at 6:40 PM with Certified Nursing Assistant (CNA) #1 and the ADON revealed that the resident began having loose stools on 12-16-11. Multiple entries had no consistency noted. There was no evidence that the physician was notified until 12-19-11 when the nurse in the Daily Skilled Nurse ' s Notes made the first notation. During an interview on 5-1-12 beginning at 6 PM, the ADON reviewed the medical record and confirmed the above information. She stated that the physician should have been notified and precautions implemented at the onset of symptoms. She was unable to explain why this had not been done. Resident #8 with [DIAGNOSES REDACTED]. Review of the hospital Transfer Discharge Summary with the ADON on 5-1-12 at 5:35 PM revealed that the resident was discharged on intravenous [MEDICATION NAME] and Zocyn to be discontinued on 12-9-11 (for treatment of [REDACTED]. The facility admitted the resident on [MEDICATION NAME] (to be stopped on 11-2-11) and contact precautions for [MEDICAL CONDITION]. Review of the Daily Skilled Nurse's Notes with the ADON revealed that the resident continued to have loose stools/diarrhea after the [MEDICATION NAME] was stopped without notification of the physician until 11-12-11. A stool specimen was sent to the lab to be rechecked on 12-6-11. There was no evidence that the physician was notified of the negative results until at least 12-14-11 as evidenced by the run date on the report. There were no initials on the document to indicate that the physician/extender had reviewed the report. During an interview on 5-1-12 beginning at 5:35 PM, the ADON reviewed the medical record and confirmed the above information. She was unable to explain why the physician had not been notified of continuing symptoms of [MEDICAL CONDITION] so appropriate interventions could be implemented. Resident #12 with [DIAGNOSES REDACTED]. Review of the Daily Skilled Nurse's Notes with the ADON on 5-1-12 at 3:45 PM revealed that from 10-29-11 at 7 PM to 10-30 11 at 7 AM, the resident continues to have small, freq(uent) amounts loose stool. 10-28-11 documented Continent of all episodes, but was not specific. She had four loose stools in twelve hours on 10/30/11. On 10/31/11, the resident had diarrhea stools three times. A stool specimen was collected and sent to the laboratory. There was no evidence that the physician was notified until a physician's order was received for the [MEDICAL CONDITION] test on 11/1/11. [MEDICATION NAME] was not ordered for treatment until 11/7/11. This physician's order noted that the indication for treatment was contact isolation precautions in place until resolved. Contact precautions were ordered again on 11/10/11. There was no evidence in the record to indicate which date the precautions were implemented though the nurses' notes showed that the resident was on contact precautions on 11/9/11. Review of the computerized ADL Records on 5-1-12 at 4:15 PM with Certified Nursing Assistant (CNA) #1 and the ADON revealed that the resident began having loose stools on 10-28-11. There was no evidence that the physician was notified until 11-1-11, 4 days later. During an interview on 5-1-12 beginning at 3:45 PM, the ADON reviewed the medical record and confirmed the above information. She stated that the physician should have been notified and precautions implemented at the onset of symptoms. She was unable to explain why this had not been done. Review of the facility policy entitled Condition Change on 5-2-12 revealed: A facility must immediately .consult with a resident's physician .when there is: .A significant change in the resident's physical .status (i.e., a deterioration in health .); A need to alter treatment significantly . During an interview on 5-1-12 at 10:15 AM, the Medical Director (and attending physician) stated he would expect to be notified immediately of signs and symptoms of [MEDICAL CONDITION] and the on-call physician/extender should be notified of the same on the weekend. If [MEDICAL CONDITION] was suspected, he would expect the facility to implement transmission-based precautions immediately, not to wait on lab reports. Cross Refer: CFR 483.65 Infection Control F441 The facility failed to notify the physician of the onset of gastrointestinal signs and symptoms of [MEDICAL CONDITIONS] in a timely manner for four of nine sampled residents reviewed with [MEDICAL CONDITION] (Residents #1, #4, #8, #12). Three of these four developed symptoms after admission to the facility (Residents #1, #4, #12). This failure to notify the physician in a timely manner resulted in significant delays in treatment and increased risk/potential for transmission of infection. The facility failed to ensure contact precautions were maintained appropriately for Residents #1, #4, #5, #6, #8, #10. Infection surveillance data was inaccurate/missing for residents who had positive test results for [MEDICAL CONDITION] (Residents #1, #4, #6, #8, #10, and #12). The Infection Preventionist (IP) was unaware of job duties and responsibilities for the infection control program. The facility failed to ensure that surveillance data was reviewed frequently enough to identify, investigate, and address the causes of any trends. Facility staff failed to identify an outbreak of [MEDICAL CONDITION] and notify the local office of the Department of Health and Environmental Control. Procedures were not in place and/or followed to ensure that facility laundry was hygienically cleaned. Procedures were not in place and/or followed to ensure appropriate daily and terminal cleaning of isolation rooms, including those rooms of residents on contact precautions for [MEDICAL CONDITION]. Cross Refer: CFR 483.75 Administration F490 related to facility administration failure to ensure that policies and procedures were in place/followed to prevent, recognize, and control the onset and spread of infection within the facility. Cross Refer: CFR 483.75(i) Medical Director F501 related to Medical Director failure to coordinate medical care in the facility to ensure that resident care was consistent with established infection control policies and procedures. Cross Refer: CFR 483.75 Quality Assessment and Assurance F520 related to QAA Committee failure to conduct ongoing reviews of the processes involved in infection control surveillance and monitoring. Staff failed to follow a plan of action established in November 2011 related to ongoing monitoring of compliance with infection control procedures. The immediacy was removed prior to exit from the facility on 5-2-12 after (1) review of the ongoing training content and participation and staff interviews related to that training were conducted, (2) evidence was presented that the medical record audits (with findings) were completed and any notifications/interventions implemented, (3) basic training was provided to the Infection Preventionist related to job duties/responsibilities, (4) the laundry was checked to ensure that it was being hygienically cleaned (5) job desciptions, duties and responsibilities were reviewed with staff members responsible for infection control data collection and analyzation. CFR 483.10(b)(11) Notification of Changes F157 was lowered to a scope and severity of E. |
2016-06-01 |