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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 540 | MERCER NURSING AND REHABILITATION CENTER | 515052 | 1275 SOUTHVIEW DRIVE | BLUEFIELD | WV | 24701 | 2018-11-29 | 744 | E | 0 | 1 | J9FW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure residents diagnosed with [REDACTED]. This was true for three (3) of three (3) residents reviewed for the care area of Dementia. Resident identifiers: #44, #45, and #92. Facility census: 97. Findings include: a) Resident #44 Record review found this seventy-five year old female was admitted to the facility on [DATE]. Current [DIAGNOSES REDACTED]. On 06/01/18, the resident's physician prescribed [MEDICATION NAME], an antipsychotic medication, .25 milligrams (mg's) two times a day (BID) for a [DIAGNOSES REDACTED]. In addition to the [MEDICATION NAME], the resident was receiving the following [MEDICAL CONDITION] medications: [REDACTED] [MEDICATION NAME] 200 mg's by mouth at bedtime for Major [MEDICAL CONDITION], recurrent, unspecified. [MEDICATION NAME] 20 mg. daily for anxiety disorder. The resident was also receiving, Memantine 10 mg's BID, for Dementia in other diseases classified elsewhere with behavioral disturbances. ( Memantine ([MEDICATION NAME]) is used to treat moderate to severe confusion (dementia) related to [MEDICAL CONDITION]. It does not cure [MEDICAL CONDITION], but it may improve memory, awareness, and the ability to perform daily functions.) On 11/27/18 at 12:38 PM, Employee #135, the corporate registered nurse (RN)coordinator, said the facility monitors resident behaviors on the psychopharmacological medication monitoring located in the electronic medical record. Review of the psychopharmacological medication monitoring with RN #135, found no behaviors were documented by nursing staff before the physician ordered [MEDICATION NAME]. Nursing notes, from 05/01/18 through 06/01/18, (the day the [MEDICATION NAME] was initiated), were reviewed with RN #135. There were no behaviors documented in the nursing notes to warrant the initiation of [MEDICATION NAME]. Further review of the physician's progress notes in the electronic medical record with RN #135 at 12:38 PM on 11/27/18, found no information regarding the initiation of [MEDICATION NAME]. On the same day the [MEDICATION NAME] was started (06/01/18, the physician also ordered a urinalysis with reflex culture and sensitivity. Review of the laboratory report with RN #135 found the resident did not have a urinary tract infection. On 8/26/18, the pharmacist reviewed the residents medications and recommended a gradual dose reduction of [MEDICATION NAME]. The physician responded with a GDR was clinically contraindicated and the medication was just started on 06/01/18. At 1:52 PM on 11/27/18, RN #135 and the director of nursing (DON) provided a copy of a nursing home visit note from the residents physician, dated 06/01/18. Both employees confirmed this note had not been scanned into the residents medical record even though it was written over over 5 months ago. The physician had written, Patient will not leave her room to attend activities stating, If I leave the bugs will come in my room and get in my bed, I have to keep the door shut to keep the bugs out, they sometimes knock on my window and try to get in. RN #135 and the DON were unable to provide any documentation to verify facility staff were aware of the delusions, attempted to talk with the resident, or provide any non-pharmacological interventions before starting the antipsychotic medication. Neither employee could find any documentation to indicate this behavior had been witnessed by other staff. Review of the residents current care plan with the DON at 9:15 AM on 11/29/18, found the resident was care planned for receiving [MEDICATION NAME] for delusion and hallucinations. The goal of the care plan was: Patient will remain free of drug related complications including movement disorder. Interventions included: Administer medications as ordered and monitor for side effects. Encourage resident to vent feelings. Monitor/record/report to physician as needed side effects and adverse reactions The DON confirmed the care plan did not discuss what staff should do when the resident had delusions and hallucinations. The DON could not demonstrate how the care plan individualized this resident's dementia care needs. At the close of the survey on 11/29/18 at 12:15 PM, no further information had been provided to substantiate other staff members had documented resident behaviors regarding hallucinations and delusions. No further information was provided to substantiate the facility utilized individualized, non-pharmacological approaches to care (e.g., purposeful and meaningful activities). Meaningful activities are those that address the resident's customary routines, interests, preferences, and choices to enhance the resident's well-being. b) Resident #45 Record review found the resident was admitted to the facility on [DATE]. Current [DIAGNOSES REDACTED].>[MEDICAL CONDITION], Dementia, and Depression. The resident was admitted with three antidepressants: [MEDICATION NAME], 75 mg. at bedtime, [MEDICATION NAME], 100 mg, three times (TID) a day [MEDICATION NAME] 30 mg. daily. The resident was not admitted with any antisychotic medication. On 01/19/18, the physician added [MEDICATION NAME] for dementia. On 06/12/18, the [MEDICATION NAME] was discontinued. On 06/13/18 [MEDICATION NAME] 20 mg., daily, was added for depression. The [MEDICATION NAME] was discontinued on 08/27/18. On 06/12/18 [MEDICATION NAME] 0.5 mg. three times a day was started for generalized Anxiety disorder. The [MEDICATION NAME] was discontinued on 11/12/18. On 06/26/18 [MEDICATION NAME] was increased from 75 mg. at bedtime to 150 mg. at bedtime. On 09/12/18, the antipsychotic, [MEDICATION NAME] 25 mg., two times (BID) a day was added to the residents medication regime. The resident continues to take the [MEDICATION NAME], and [MEDICATION NAME]. At 1:00 PM on 11/28/18, the Director of Nursing, (DON) was asked where the facility would have documented any behaviors and non-pharmacological interventions before starting the antipsychotic, [MEDICATION NAME]. On 11/28/18 at 02:41 PM, the DON said, I have looked for non pharmacological interventions, there aren't any documented. The DON said the resident was physically aggressive towards staff and other residents. The DON provided a copy of the nurse practioners (NP) visit, dated 09/12/18. The NP noted the resident had been trying to run over other residents with her wheelchair and was refusing to take her medications and cursing at staff. The Medication Administration Record [REDACTED]. According to the documentation on the MAR, the resident had taken all her medications. The DON was asked if the facility had any incident/accident reports regarding the physical aggression towards other residents? Review of the care plan with the DON found the following interventions were to be implemented when the resident exhibited behaviors: Analyze key times, places, circumstances, triggers and what de-escalates behavior and document. assess patients coping skills and support system When patient becomes agitated: Intervene before agitation escalates; guide away from source of distress; engage calmly in conversation if response is aggressive staff to walk calmly away, and approach later. Anticipate and meet patients needs to reduce behavioral symptoms. Intervene as necessary to protect the rights and safety of others. Approach/Speak in a calm manner. Divert attention. Remove from situation and take patient to alternate location as needed. Monitor behavior episodes and attempt to determine underlying cause. Consider location time of day persons involved and situations. Document behaviors and potential causes. Report findings to attending physician and or update care plan as appropriate. Privately discuss inappropriate behaviors with patient and explain why his her behavior is unacceptable in the nursing facility. Document discussion. Report outcome to physician and or update care plan as appropriate. The DON was asked to provide information to substantiate the above approaches were implemented as directed by the care plan. During an interview with the DON and administrator on 11/29/18 at 10:34 AM, the DON said, I have nothing else to give you. c) Resident #92 A review of Resident #92's medical record at 12:03 p.m. on 11/28/18 found a physician's orders [REDACTED]. This was ordered on [DATE] by Resident #92's attending physician. The physician progress notes [REDACTED].ORIENTATION: Normal- Alert and orientated X 1. Affect is broad. No visible signs of anxiety or depressed state. Patient is delusional and manic today. They won't let me take care of my husband like I need to, these dogs treat him awful in here. Care Plan .[MEDICAL CONDITION]: [MEDICATION NAME] .25 mg by mouth BID (twice a day). Continue behavior/affect monitoring. Further review of the medical record found Resident #92 use to be a Nurse Aide and her husband is also a resident at this facility. A review of the record from 07/01/18 through 07/31/18 found no documentation of any behaviors from Resident #92 that would justify the use of an antipsychotic medication. The care plan was reviewed and found the following focus statement added to the care plan on 08/03/18, (Last Name of Resident #92) receives antipsychotic medications ([MEDICATION NAME]) r/t behavior management AEB (as evidenced by ) wandering, attempting to provide care to other residents. The goal associated with focus statement was as follows, Patient will be/remain free of drug related complications including movement disorder, discomfort, [MEDICAL CONDITION], gait disturbance, constipation/impaction or cognitive/behavioral impairment through review date. The interventions related to this focus statement and goal include:, Administer medications as ordered. Monitor/document for side effects and effectiveness. Encourage family and friends to visit. Encourage out of room activities, such as church activities and special singing. She likes to visit with her husband who resides at the facility Monitor/record/report to physician prn (as needed) side effects and adverse reactions of psychoactive medications : unsteady gait, tardive dyskinesia, EPS (shuffling gait, rigid muscles, shaking), frequent falls, refusal to eat, difficulty swallowing, dry mouth, depression, suicidal ideation's, social isolation, blurred vision, diarrhea, fatigue, [MEDICAL CONDITION], loss of appetite, weight loss, muscle cramps, nausea, vomiting, behavior symptoms not usual to one person. Redirect resident when she attempts to provide care for other residents in the facility. The care plan goal and interventions was added after the medication was started. The care plan contains no non pharmacological interventions and there was no indication any non pharmacological interventions were put into place prior to starting the medication [MEDICATION NAME]. During an interview with the Director of Nursing (DON) at 1:37 p.m. on 11/18/18 the above findings were reviewed with her. She was asked to provide any information the facility had in regards to why Resident #92 was started on [MEDICATION NAME] and for any non pharmacological interventions they had in place prior to starting the medication. An interview with Registered Nurse #52 at 2:12 p.m. on 11/28/18 confirmed there was no documented behaviors in the medical record. She stated they looked to see what behaviors led to Resident #92 being started on [MEDICATION NAME] and there was none documented in the medical record. | 2020-09-01 |