cms_WV: 11181
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 11181 | HEARTLAND OF PRESTON COUNTY | 515072 | 300 MILLER ROAD | KINGWOOD | WV | 26537 | 2009-02-12 | 428 | E | 1 | 0 | IH3P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of manufacturer's dosing instructions, and staff interviews, it was determined the pharmacist had not identified drug irregularities for five (5) residents. The pharmacist had not identified the facility's current scheduling of antibiotics as an irregularity. The current schedules for antibiotics did not maintain blood levels of the medication for optimal effect. Two (2) of nineteen (19) residents on the sample were identified as being affected, and review of the February medication administration records (MAR) for the 100 hall identified an additional two (2) residents. Additionally, the pharmacist had not identified that Resident #107 was receiving Melatonin for an excessive duration. Resident identifiers: #52, #15, #95, and #51. Facility census: 106. Findings include: a) Residents #15, #51, #52, and #95 1. Resident #15 Review of the resident's medical record found that, on 01/19/09, Augmentin (an antibiotic) had been ordered given three (3) times a day pending the culture of the resident's tracheostomy site. Review of his MARs revealed the antibiotic had been scheduled for administration at 8:00 a.m., 12:00 p.m., and 5:00 p.m. That meant the three (3) antibiotic doses were given in an approximately nine (9) hour period, leaving fifteen (15) hours between the 5:00 p.m. dose and the 8:00 a.m. dose on the following day. 2. Resident #51 The resident's current orders included Bactrim DS to be given twice a day for five (5) days. The antibiotic was scheduled for administration at 9:00 a.m. and 5:00 p.m. on the MAR. This schedule provided for the doses for one (1) day to be given eight (8) hours apart, and the next dose would not be given for approximately sixteen (16) hours. Review of the pharmacist's drug regimen review for Resident #51, dated 02/02/09, found the schedule for the Augmentin the resident received in January 2009 had not been noted as an irregularity. 3. Resident #52 The resident's current MAR indicated [REDACTED]. The antibiotic was scheduled for administration at 8:00 a.m., 12:00 p.m., and 5:00 p.m. 4. Resident #95 A current order for Bactrim DS to be given twice a day for ten (10) days was noted on the resident's current MAR. The medication was scheduled to be given at 8:00 a.m. and 5:00 p.m. 5. The director of nursing was interviewed on 02/11/09. When asked about the scheduling of antibiotics, she was unable to offer a reason for the current schedules. She said that these were the schedules used for the medications ordered given two (2) or three (3) times a day - that she had not thought about the antibiotics. When asked whether the pharmacist had identified this as an irregularity in the reports she received, she said he/she had not. 6. Review of package inserts (obtained for in the Food and Drug Administration's website) from the pharmaceutical companies for each of these antibiotics found that, under the section for "Dosage and Administration", each included instructions that doses should be administered every twelve (12) hours if the medication was given twice a day and every eight (8) hours if given three (3) times a day. e) Resident #107 Medical record review, conducted on the morning of 02/05/09, revealed Resident #107 was receiving Melatonin since 05/17/08. Review of the original physician order [REDACTED]. According to http://www.mayoclinic.com/health/melatonin/NS_patient-melatonin: "Melatonin should be used for short term therapy three (3) months or less and possible side effects include fatigue, dizziness, headache, irritability and sleepiness." Review of the monthly drug regimen review found no evidence the consultant pharmacist had recognized as an irregularity that Resident #107 had been receiving this medication for an excessive duration. During an interview on the afternoon of 02/10/09, the director of nursing (DON - Employee #5) offered to review the medical record to determine whether the consultant pharmacist identified this irregularity. Shortly after this interview, the DON identified that the consultant pharmacist did not identify this irregularity until 02/02/09, and the consultant report was in a separate file for the physician to review; it was not in this resident's closed medical record. The facility failed to ensure that Melatonin was not given in an excessive duration. | 2014-07-01 |