cms_WV: 11474
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 11474 | TEAYS VALLEY CENTER | 515106 | 590 NORTH POPLAR FORK ROAD | HURRICANE | WV | 25526 | 2010-12-09 | 328 | D | 6HW412 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on observation, resident interview, staff interview, medical record review, and policy review, the facility failed to ensure one (1) of ten (10) sampled residents received the maximum benefit of each aerosolized treatment ordered by her physician. Resident #111, whose [DIAGNOSES REDACTED]. She had a physician's order permitting her to self-administer the aerosolized treatments; however, there was no evidence the interdisciplinary team completed an assessment to ensure the resident was capable of reliably self-administering these treatments, and this self-administration of aerosolized medications was not addressed on her care plan. Licensed nursing staff was aware Resident #111 did not self-administer these treatments in an effective manner, and they did not provide additional monitoring / supervision to ensure she received the maximum benefit of each treatment. Additionally, licensed nursing staff did not complete pre- and post-treatment assessments that would allow them to determine whether the treatments were effective. Resident identifier: #111. Facility census: 113. Findings include: a) Resident #111 1. Observation, during tour on 12/06/10 at 2:10 p.m., found Resident #111 sitting in her room holding a medicine cup attached to a nebulizer. The medicine cup had a small amount of liquid in it. The resident stated she needed her breathing treatment set up, that she was supposed to have received it at 1:00 p.m. The resident stated she asked both a nursing assistant and her nurse (Employee #21, a licensed practical nurse - LPN) for the treatment. In an interview on 12/06/10 at 2:15 p.m., Employee #21 said she set up the treatment for [REDACTED]. She reported the resident does the treatment herself after the nurse sets up the treatment, which includes putting the medication into the medicine cup. The resident then hits the button to turn on the machine when she is ready and self administers the treatment. The nurse then accessed the medication cart and took out Atrovent and [MEDICATION NAME] and went to the resident's room to set up the medication for Resident #111. -- 2. A physician's order, dated 11/23/10, stated, "Res (resident) may administer [MEDICATION NAME] / Atrovent treatments herself." An earlier order, dated 08/05/10, stated the resident was to receive Atrovent 2% Inhaler, one (1) unit dose every four (4) hours administered via nebulizer, give with [MEDICATION NAME]; and [MEDICATION NAME] 0.083%, one (1) unit dose every four (4) hours administered via nebulizer, give with Atrovent. Review of the resident's December 2010 Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED] -- 3. Review of the resident's minimum data set assessment (MDS) history, beginning with an MDS dated [DATE] and continuing through the most recent MDS dated [DATE], revealed the resident was identified as being unable to self-medicate. Review of the resident's medical record failed to find evidence the resident was assessed for the ability to self-medicate. Review of the resident's care plan, dated 10/26/08 and revised on 09/30/10, found the resident was identified as "Exhibiting or is at risk for complications related to [MEDICAL CONDITION]", but there was no mention of the resident having been identified by the interdisciplinary team as being able to self-administer medications, and her care plan was not revised to address the self-administration of her aerosolized breathing treatments after the physician's order was written to permit this on 11/23/10. -- 4. The resident, when interviewed again on 12/06/10 at 4:15 p.m., reported she did not receive her 5:00 a.m. nebulizer treatment either. She said that, when the nurse set up the nebulizer, she was smoking and when she returned from smoking, most of the medication in the cup to the nebulizer had drained from the cup. She tried to utilize the medication remaining in the cup and it was not effective. She stated that, when this happens, she becomes short of breath. -- 5. A subsequent interview with Employee #21, on 12/06/10 at 4:30 p.m., found the resident's next scheduled nebulizer treatment was due at 5:00 p.m., but she would wait until 5:45 p.m. before administering the next treatment. This would only allow two (2) hours and forty five (45) minutes between treatments. Employee #21, when asked if the nurse on the night shift had reported to her that Resident #111 did not receive an effective treatment at 5:00 a.m., responded that she did not. The nurse reported that she marks the treatment as given on the MAR indicated [REDACTED]. The nurse stated she did not assess the resident's heart rate, respiratory rate, and breath sounds prior to initiating a treatment and after each treatment was finished. -- 6. Review of the facility's policy titled "2.12 Medications: Self Administration" (effective 06/01/96 and revised 01/01/04) revealed the following, "Process: "1. When a customer requests medication self administration, initiate the process to assess customer's capability. The customer must meet the follow criteria. "1.1. Be able to demonstrate: "1.1.1. Knowledge of medications and medication schedule "1.1.2. Self-administration including use of packaging, reading label, open containers; and "1.1.3. Ability to administer medications properly, e.g., insulin / syringe, eye drops, inhalers as needed. "2. If assessment indicates customer is capable of medication self-administration, notify physician to obtain order. "3. Address medication self-administration in customer's care plan. Include plan for: "3.1. Storage, location of medications, and documentation of medication administration; "3.2. Education for customer / family regarding medication self-administration process, specific medication information and safe, effective use of medications, and "3.3. Ongoing monitoring and reassessing of customer's capacity. "4. Securing medications at the nursing station. Keep a limited quantity in a locked drawer at customer's bedside. Assure that customer and nursing both have a key. "5. Instruct customer in medication self-administration procedure. Include: "5.1. Obtaining medication "5.2. Administering medication according to physician order; "5.3. Recording administration on documentation record. "6. Monitor customer to assure medication is administered as ordered and for effectiveness and/or side effects of medication. "6.1. Notify physician of any side effects of changes in condition that may require medication adjustment. "6.2. Notify physician and care plan team if customer demonstrates decrease in capability for medication self-administration. "7. Adjust plan for medication self-administration as indicated. "8. Document: "8.1. Customer's request and assessment of capability in Nurses' Notes or progress notes; "8.2. Plan for storage, location, documentation, education, and monitoring on customer's care plan; "8.3. Ongoing monitoring of customer's capability in Nurses' Notes." -- 7. Review of the "Assessment for Self-Administration of Medications" (dated 1992), found the following instructions: "Before performing this assessment, verify that there is a physician order in the resident's chart for self-administration of the specific medication under consideration and that the resident has signed the appropriate document stating the desire to self-administer his/her own medication. Proceed by checking the appropriate response below for each of the 19 items listed. The resident must be able to perform each step indicated below prior to beginning self-administration of medications. The interdisciplinary team will be responsible for approving self-medication using the assessment as a guide." Item #19 of the assessment asked, "Can administer inhalant medication with proper procedure?" -- 8. Review of the resident's MAR found the form used for documenting self-administration of medications titled "Self Medication Administration Record" was not utilized. -- 9. Review of the facility policy titled "11.21 Small Volume Nebulizer" (dated 01/01/04 and revised 06/01/04), revealed at Item #8, before a nurse administered medications utilizing a nebulizer, the nurse was supposed to: "Assess the patient's heart rate, respiratory rate, and breath sound prior to initiating treatment." Item #20 stated, "Upon completion of the treatment, check patient's heart rate, respiratory rate, and breath sounds." -- 10. On 12/07/10 at 10:00 a.m., the interim director of nursing was interviewed and additional information was requested. As of exit on 12/09/10 at 12:00 p.m., no additional information was provided with respect to the above concerns. . | 2014-02-01 |