| 7935 |
ANSTED CENTER |
515133 |
96 TYREE STREET |
ANSTED |
WV |
25812 |
2012-12-11 |
329 |
D |
0 |
1 |
K06L11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, physician interview, and staff interview, the facility failed to ensure two (2) of ten (10) sample residents' medication regimens were free from unnecessary medications. One (1) resident received multiple doses of laxatives, including invasive laxatives, and the antipsychotic [MEDICATION NAME] with no indication for its use. Another resident received [MEDICATION NAME] without adequate indication for its use and without an attempt at a gradual dose reduction. Resident identifiers: #66 and #11. Facility census: 60. Findings include: a) Resident #66 (Laxatives) 1) Medical record review identified Resident #66 had a diagnoses of constipation. Further review of the medical record identified this resident did not have an individualized medication regimen for the constipation. According to the medical record, the resident had frequently been given medications from the facility's standing orders for constipation. No interventions, other than frequent use of laxatives, were put in place to relieve the resident of constipation. The facility continued the use of the standing orders for constipation. There was no evidence the physician was notified of any issues of constipation with this resident. The following laxatives were given to the resident for constipation. This included giving an invasive suppository on a regular basis. -- 08/25/12 - Milk of Magnesia given -- 09/15/12 - [MEDICATION NAME] suppository given -- 09/26/12 - Milk of Magnesia -- 10/03/12 - Milk of Magnesia -- 10/09/12 - Milk of Magnesia -- 10/13/12 - Milk of Magnesia Review of the medical record identified an order dated 10/23/12, by the attending physician, for the resident to have Senna S two (2) capsules at bedtime. During an interview with the DON, on 12/06/12 at 1:30 p.m., it was confirmed this resident was never ordered routine medication for constipation until 10/23/12. Further review of the medical record identified the Senna was ineffective, and the facility continued to use the standing orders. No evidence was found the facility identified the Senna was not working and/or notified the physician. The facility continued to administer laxatives, including the invasive suppository, as a regular routine for constipation: -- 10/24/12 - Milk of Magnesia -- 11/06/12 - Milk of Magnesia -- 11/07/12 - [MEDICATION NAME] suppository -- 11/11/12 - Milk of magnesia -- 11/12/12 - [MEDICATION NAME] suppository -- 11/16/12 - Milk of magnesia -- 11/17/12 - [MEDICATION NAME] suppository -- 11/20/12 - Milk of magnesia -- 11/21/12 - [MEDICATION NAME] suppository -- 11/24/12 - Milk of magnesia -- 11/25/12 - [MEDICATION NAME] suppository -- 11/28/12 - Milk of Magnesia -- 11/29/12 - [MEDICATION NAME] suppository -- 12/02/12 - Milk of Magnesia -- 12/03/12 - [MEDICATION NAME] suppository -- 12/07/12 - Milk of Magnesia -- 12/08/12 - [MEDICATION NAME] suppository On 12/06/12 at 1:30 p.m., the DON confirmed the facility failed to recognize the resident was receiving multiple doses of laxatives on a regular basis from the standing orders. Further confirmation was obtained from the physician, with the DON present, during a conference call on 12/11/12 at 2:30 p.m. He confirmed there was a failure to recognize the resident was receiving multiple doses of medication for constipation. He stated the facility now had a plan in place for additional interventions for constipation for this resident. 2) Resident #66 ([MEDICATION NAME]) Review of the medical record identified Resident #66 was given [MEDICATION NAME], an anti-psychotic medication, for dementia with behaviors. During an interview with the DON on, 12/11/12 at 1:45 p.m., it was identified the medication was ordered related to the resident pacing, wandering, and walking with a shuffling gait. An interview was conducted with the attending physician and the DON, via a telephone conference on 12/11/12 at 2:30 p.m. The physician stated the medication was given so Resident #66 would not get up without asking for assistance, possibly resulting in a fall. The attending physician stated the [MEDICATION NAME] would keep the resident from pacing and shuffling, and he felt this out weighed the risk of her falling. Review of the medical record revealed no behaviors which warranted the use of [MEDICATION NAME]. On 12/11/12 at 1:45 p.m., the DON provided the following documentation which she referred to as behaviors: 02/09/12 -- Gait shuffled and unsteady 02/11/12 -- Resident pacing x 3 from bed 02/11/12 -- Has unsteady shuffling gait 02/19/12 -- shuffle gait 02/22/12 -- has a shuffle gait, staff reminds resident to take steps 02/22/12 -- up x 5 ambulating from room to hallway 02/22/12 -- resident has a shuffle gait 02/23/12 -- has a steady shuffle gait 02/23/12 -- less shuffling noted Medical record review found no current documentation related to the resident wandering and walking with a shuffling gait. Resident #66 used a wheelchair for ambulation and sometimes used a walker. She also required assistance of one (1) with a gait bait. On 10/03/12, Employee #35 (a registered nurse) updated the care plan for Resident #66. It stated, . resident rarely leaves room and she does not wander. This finding was confirmed with the DON on 12/11/12 at 1:10 p.m. Review of the care plan for the use of [MEDICAL CONDITION] medications found no evidence [MEDICATION NAME] was used for shuffling gait or wandering. In addition, there was no evidence of any behaviors which warranted the use of an antipsychotic medication. The care plan for [MEDICAL CONDITION] medications was last updated on 01/19/12. Further review of the care plan found no interventions had been added to the care plan since 01/19/12. Review of the social service assessments, dated 04/25/12 and 08/01/12, identified the resident had not experienced any of the following behaviors: -- hitting others -- kicking -- pushing -- scratching -- grabbing -- abusing others sexually -- threatening others -- pacing This resident was given the antipsychotic medication, [MEDICATION NAME], without adequate indications for its use. b) Resident #11 Medical record review, on 12/10/12, revealed a pharmacy consultation report dated 10/17/12. The report stated Resident #11 had a physician's orders [REDACTED]. As of 12/10/12, the order dated 09/11/12 had not been initiated. The resident was currently receiving the medication two (2) times daily. When interviewed, on 12/10/12, regarding why the ordered medication decrease had not been instituted, the DON stated the medical power of attorney for Resident #11 refused to allow suggested medication reductions. The pharmacy consultant report, dated 10/17/12, was signed by the DON. It stated, Family had been contacted regarding change & had not given consent for medication change. The report did not indicate which family member made that decision and/or if that person was the resident's medical decision maker. Additionally, there was no evidence the medical decision maker had been made aware of the pros and cons related to continuing the use of [MEDICAL CONDITION] medication for this ninety-one (91) year old resident. Further review of the medical record revealed [MEDICATION NAME] XR 150 mg twice a day was prescribed for Resident #11 for [MEDICAL CONDITION] not elsewhere classified and dementia conditions classified elsewhere (CCE) with behavioral disturbances. There was no [DIAGNOSES REDACTED]. The minimum data set (MDS) with an assessment reference date (ARD) of 11/12/12, Section E, revealed Resident #11 did not display potential indicators of [MEDICAL CONDITION] and did not display: a) physical behavioral symptoms directed toward others, b) verbal behavioral symptoms directed toward others c) other behavioral symptoms not directed toward others. In addition, behavioral flow sheets for the months of October and November 2012 revealed Resident #11 did not display any of the above behaviors. An inquiry was made regarding what behaviors the resident displayed that would necessitate this medication. Nursing note documentation, beginning in 2008, was provided by the DON. It indicated the resident once exhibited acting out behaviors, such as striking out at other residents. However, no recent behavior problems were noted. The only recent negative behavior was noted on an incident report dated 06/21/12. It stated Resident #11 hit another resident while in the dining room. Further review of a change in condition nursing note dated 06/20/12, near the time of the incident, revealed Resident #11 was positive for [MEDICATION NAME] cloacae (a urinary tract infection). Urinary tract infections can cause behavior changes in the elderly population. The resident did not display behaviors that would necessitate the continued use of the [MEDICATION NAME]. The use of this medication, without adequate indication for its use and/or without evidence attempts at a dose reduction was clinically contraindicated, resulted in this resident being provided an unnecessary medication. |
2016-12-01 |