cms_WV: 2147
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2147 | ANSTED CENTER | 515133 | PO BOX 400 | ANSTED | WV | 25812 | 2019-09-24 | 580 | E | 1 | 0 | 9CH711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and staff interview, the facility failed to notify the physician when medications were not administered. This is true for two (2) out of five (5) residents Medication Administration Record [REDACTED]. Facility census: 59. Findings included: a) Resident #2 A review of Resident #2's MAR indicated [REDACTED]. --Apixaban 5 milligrams (mg) twice a day at 9:00 AM and 9:00 PM --Aspirin 81 mg daily at 9:00 AM --[MEDICATION NAME] ([MEDICATION NAME]) 0.5 mg twice a day at 9:00 AM and 9:00 PM - [MEDICATION NAME], a schedule IV medication, was signed off on the controlled substance book indicating the nurse had taken the medication out of the pack, but Nurse #1 signed her initial on the dates and times on the MAR indicated [REDACTED]. The medication [MEDICATION NAME] was not sign off with another nurse on the controlled substance book that the medication was wasted. This means the medication was not observed by another nurse the medication was disposed of properly. --Carvedilol 3.125 mg twice a day at 9:00 AM and 9:00 PM --[MEDICATION NAME] 25 mg daily at 9:00 AM --[MEDICATION NAME] 20 mg daily at 9:00 AM --[MEDICATION NAME] 10 mg daily at 9:00 AM --[MEDICATION NAME] 7.5 mg at 9:00 PM --[MEDICATION NAME] Chloride extended release 15 mg daily at 9:00 AM --[MEDICATION NAME] 20 mg daily for at 9:00 AM --Vitamin B 12 100 microgram (mcg) daily at 9:00 AM The Director of Nursing (DoN) stated the nurse who did not administer Resident #2's medication on 09/03/19 was Nurse #1. She further stated when a nurse circles her initals on the dates and times on the MAR, this indicates the nurse did not administer medication to the resident. Nurse #1 did not notify the physician why the medication were not administer to Resident #2. b) Resident #5 A review of Resident #5's MAR indicated [REDACTED]. When a nurse circles her initals on the date and times, this indicates the nurse did not administer these medication to the Resident #5. The Nurse did not notify the physician why they did not administer the following medication to Resident #5. On 06/01/19, 06/02/19 and 06/03/19 at 9:00 AM, Resident #5 was not administered the following medications: [REDACTED] --[MEDICATION NAME] Sodium 100 mg --[MEDICATION NAME] 1 mg On 06/01/19, 06/02/19, 06/03/19 and 06/05/19 at 2:00 PM, Resident #5 was not administered the following medication: --[MEDICATION NAME] 1 mg On 06/01/19, 06/02/19 and 06/03/19 at 2:00 PM, Resident #5 was not administered the following medication: --[MEDICATION NAME] ([MEDICATION NAME]) 1 mg - Resident #5's [MEDICATION NAME]- schedule IV medication was signed off on the controlled substance book on 06/01/19, 06/02/19, 06/03/19 to revealing the nurse had taken the medication out of the pack, signed their initial on the dates and times on the MAR indicated [REDACTED]. The medication [MEDICATION NAME] ([MEDICATION NAME]) was not sign off with another nurse on the controlled substance book that the medication was wasted. This means the medication was not observed by another nurse the medication was disposed of properly. On 06/01/19 and 06/02/19 at 9:00 AM, Resident #5 was not administered the following medication: --[MEDICATION NAME] 5 mg On 06/02/19 and 06/03/19 at 9:00 AM, Resident #5 was not administered the following medication: --[MEDICATION NAME] 24 mcg --[MEDICATION NAME] 0.5 mg Resident #5 was re-admitted on [DATE] at 11:12 AM. The physician (physician name) approved all admission orders [REDACTED] A review of Resident #5's MAR indicated [REDACTED]. The MAR indicated [REDACTED]. Resident #5 did not receive her medication [MEDICATION NAME] ([MEDICATION NAME]) 1 mg on 07/04/19 at 2:00 PM as ordered nor did the nurse notify the physician. A review of the controlled substance book to determine whether [MEDICATION NAME] - schedule IV medication to treat Resident #5's Anxiety had been removed on 07/04/19 at 2:00 PM, found no [MEDICATION NAME] ([MEDICATION NAME]) had been remove from the controlled substance pack. Therefore the [MEDICATION NAME] ([MEDICATION NAME]) one (1) MG by mouth was not administered to Resident #5. On 07/0419 07/07/19, 07/15/19 and 07/16/19, more than one nurse circled their initial on the dates and times for the following medication on the MAR, meaning the medication were not administered to the Resident #5. The nurses did not notify the physician why they did not administer the following medication to Resident #5. Resident #5 was not administered the following medication on 07/07/19 at 9:00 AM --[MEDICATION NAME] 24 mcg daily --[MEDICATION NAME] 5 mg --[MEDICATION NAME] 100 mg --[MEDICATION NAME] 2.5 mg Resident #5 was not administered the following medication on 07/1519 and 07/16/19 at 9:00 AM: --[MEDICATION NAME] 24 mcg was circled, indicating LPN #7 did not administer this medication. LPN #7 did write on the back of the MAR indicated [REDACTED]. Resident #5 was not administered the following medication on 07/15/19 and 07/16/19 at 9:00 AM: --[MEDICATION NAME] 5 mg --[MEDICATION NAME] 100 mg --[MEDICATION NAME] 2.5 mg --[MEDICATION NAME] 0.5 mg On 07/16/19 Resident #5 was sent to a Behavioral Health hospital (hospital name).The hospital performed a [MEDICATION NAME] Level on 07/17/19 in which the results were 15.5 ng/ml (A ng means- nanograms per ml - milliliter, which is abbreviated as ng/ml. This is the unit of measure most commonly used to express drug testing cut-off levels and quantitative test results. Normal range for [MEDICATION NAME] level range is from 50.0 - 240. The test detect presence of [MEDICATION NAME], a benzodiazepine sedative and anticonvulsant. A quantitative test tells you how much (the quantity) of an analyte is present. Hx benefits states [MEDICATION NAME] ([MEDICATION NAME]'s) half life is approximately 12 hours, which means that once you have taken your last dosage of [MEDICATION NAME] ([MEDICATION NAME]), it would take about 2.75 days for Lorazapam ([MEDICATION NAME]) to be full out of your body. A review of Resident #5's medical record finds on 09/24/19 at 11:40 AM, the physician was not notified Resident #2 and 5's medication were not administered as ordered. In an interview with the Director of Nursing (DoN) on 09/24/19 at 11:50 AM, she was shown the MAR'S for Resident #2 and #5. The DoN, stated that, the MAR indicated [REDACTED]. The DoN also revealed she could not provide evidence on whether the [MEDICATION NAME] ([MEDICATION NAME]) which is a (controlled Substance),( schedule IV)was given. The DoN stated all she can say is for Resident #2, the nurse took out the medication from the lock box, but what she did with the medication she cannot verify, because the nurse wrote the resident did not receive the medication [MEDICATION NAME] ([MEDICATION NAME]), and the medication was not wasted with another nurse on duty. On 06/01/19, 06/02/19 and 06/03/19 at 2:00 PM, the DoN confirmed the [MEDICATION NAME] ([MEDICATION NAME]) was removed from the pack and signed off as given, but the MAR indicated [REDACTED]. The DoN stated that on 07/04/19 Resident #5 did not receive her medication [MEDICATION NAME] ([MEDICATION NAME]) at 2:00 PM as ordered, because the medication was never taken out of the package when she should have received the medication. DoN revealed their policy is if a resident refuses the medication they are to circle their initals on that date and time and document the residents refusal of the medication on the back of the MAR, and if the medication is a controlled substance, the nurses must waste the medication with another nurse and sign off the resident refuses the medication. DoN stated her expectation would be if the resident refused any of their medication they should notify the physician. The DoN confirmed one (1) nurse did circle her initals, and wrote a rational for not administering the medication [MEDICATION NAME] on 07/15/19 and 07/16/19, but she did not notify the physician. The DoN stated, for the rest of the nurses they did not write on the back of the MAR, waste the [MEDICATION NAME] ([MEDICATION NAME]) with another nurse correctly and notify the physician the medication were not administered to Resident #2 and #5. The facility's policy for medication refused by resident, finds the nursing staff is to circle their initals, in the date and time space where that medication is ordered, and document patient's refusal of medication of the back of the MAR. The facility's pharmacy (pharmacy name) policy is to Wasted controlled substances should be destroyed with another appropriate observer and documented as a per facility policy. The pharmacy policy says to document omitted doses and why. A professional standard of practice of medication Administration -August 2013, reveals the nurse must notify the prescribing practitioner or supervisor when a resident refuses medication. RN. ORG finds that when controlled substances must be disposed of, the disposal should be witnessed by two (2) healthcare providers who are licensed to dispense drugs, such as two RNS, and the disposal documented with both healthcare providers signing. This should be done immediately after procuring the drug. The nurse should not carry the excess narcotic on a tray or in a pocket or place it in an unsecured medication drawer for later disposal because this increases the risk of diversion or errors in documentation but should immediately ask for a witness and dispose of the drug according to established protocol. | 2020-09-01 |