cms_WV: 10328
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10328 | CEDAR RIDGE CENTER | 515087 | 302 CEDAR RIDGE ROAD | SISSONVILLE | WV | 25320 | 2011-01-13 | 329 | D | 0 | 1 | I28Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on medical record review and staff interview, the facility failed to ensure each resident's drug regimen was free from unnecessary drugs. Two (2) of ten (10) residents selected by the ASE-Q software for unnecessary drug review were found to have a lack of documentation of the resident-specific rationale for continuation of the use of psychopharmacological medications. Resident identifiers: #72 and #65. Facility census: 113. Findings include: a) Resident #72 Record review revealed this [AGE] year old male resident had [DIAGNOSES REDACTED]. Review of the medication changes since 01/01/10 to present found the dosage for Klonopin (a benzodiazepine) had remained the same. Review of the current physician's orders [REDACTED]. The medication had been ordered for behaviors manifested by verbal outbursts and / or hitting. He was noted to have dementia with behavioral disturbances. On 03/14/10, the pharmacist had issued a consultation report that included, "(Resident's name) behavior medications are up for annual review for dosage reduction. He is on: [MEDICATION NAME] 20 mg daily Klonopin 0.5 mg TID (three (3) times a day)." The recommendation from the pharmacist was: "Please consider a gradual dose reduction, perhaps decreasing the Klonopin to BID (two (2) times a day) while concurrently monitoring for re-emergence of target and / or withdrawal symptoms. If therapy is to continue at the current dose, please provide rationale describing a dose reduction as clinically contraindicated." For "Rationale for Recommendation", the report had: "Federal nursing facility regulations require that a gradual dosage reduction (GDR) be attempted in two separate quarters within the first year in which and individual is admitted on a psychopharmacologic medication or after the facility has initiated such medication, and then annually UNLESS CLINICALLY CONTRAINDICATED." The physician checked that he "declined" the recommendation beside the statement "Continued use is in accordance with the current standard of practice and a GDR attempt at this time is likely to impair this individual's function or cause psychiatric instability by exacerbating an underlying medical condition or psychiatric disorder (as outlined below)." Below the checked statement was: "Please provide CMS REQUIRED patient-specific rationale why a GDR attempt is likely to impair function or cause psychiatric instability in this individual:" Nothing was recorded on lines provided on the form for noting this rationale. No additional information was found in review of the physician's progress notes written since 03/14/10. The physician had not provided the requisite documentation regarding why a gradual dose reduction was clinically contraindicated for Resident #72. -- b) Resident #65 Review of this [AGE] year old resident's medical record found she had current physician's orders [REDACTED]. On 02/11/10, the pharmacist had noted the resident was on [MEDICATION NAME] 15 mg at bed time and [MEDICATION NAME] 25 mg daily. It was also noted that the resident was receiving [MEDICATION NAME] 50 mg BID and [MEDICATION NAME] 0.25 mg BID with 0.25 mg daily PRN (as needed). The pharmacist noted the PRN order had been reduced in July. Also in this "Comment" section was: "No other attempts at changing her medications for years." Review of the resident's current physician orders [REDACTED]. The dosage for [MEDICATION NAME] and [MEDICATION NAME] remained the same. The routine [MEDICATION NAME] dose remained the same, but there was no PRN order currently. The recommendation from the pharmacist was: "Please consider a gradual dose reduction of one or more of the medications while concurrently monitoring for re-emergence of target and / or withdrawal symptoms. If therapy is to continue at the current dose, please provide rationale describing a dose reduction as clinically contraindicated." For "Rationale for Recommendation" the report had: "Federal nursing facility regulations require that antipsychotics being used to manage behavior or stabilize mood undergo gradual dose reduction (GDR) attempts in two separate quarters within the first year in which a resident is admitted on one of these medications or after the facility has initiated such medication, and then annually UNLESS CLINICALLY CONTRAINDICATED." The physician checked: "I accept the recommendation(s) above WITH THE FOLLOWING MODIFICATION(S):" and wrote "D/C (discontinue) [MEDICATION NAME]." Nothing was written to address the continued use of [MEDICATION NAME], and [MEDICATION NAME]. No additional information was found in review of the physician's progress notes written since 02/11/10. The physician had not provided the requisite documentation regarding why a gradual dose reduction was clinically contraindicated for these medications for Resident #65. -- c) The above was discussed with the director of nursing the afternoon of 01/12/11. She acknowledged the lack of physician documentation in response to the pharmacist's recommendations and noted the documentation should have been made on the pharmacist's consultation forms. . | 2015-05-01 |