cms_WV: 8626

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

This data as json, copyable

rowid facility_name facility_id address city state zip inspection_date deficiency_tag scope_severity complaint standard eventid inspection_text filedate
8626 WAR MEMORIAL HOSP, D/P 5.1e+151 1 HEALTHY WAY BERKELEY SPRINGS WV 25411 2012-12-07 329 E 0 1 L97I11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and facility policy and procedure, the facility failed to ensure that medication regimens were free from unnecessary drugs. This includes duplicate therapy, excessive duration, and lack of adequate indications for administration as well as incomplete orders. In addition, the facility failed to ensure that residents receiving antipsychotic drugs receive gradual dose reduction unless clinically contraindicated. This is true for four (4) of eleven (11) stage two (2) sampled residents. Resident identifiers: Resident #5, #16, #3, and #2. Facility census sixteen (16). Findings include: a.) Resident #5 A record review performed on 12/4/12 of physician's order [REDACTED]. No indication for usage was listed. The medication administration records (MARs) for October 2012 and November 2012 verify this medication was never administered during that time period and no stop date was provided. Another order dated 11/22/2010 for Tylenol 650 mg suppository was incomplete as it did not specify a route for administration. This information was discussed with the Director of Nursing (DON) on 12/5/12 at 2:30 p.m. and she was unable to provide further information. According to the facility policy and procedure titled Stop Orders , All PRN {as needed} orders, except for [MEDICATION NAME], are discontinued in 60 days if not utilized at all during that time, unless the prescriber specifically orders them to be continued indefinitely or for a specified period of time. b.) Resident #16 Resident #16 was admitted on [DATE] with an order for [REDACTED]. A second request from pharmacy dated 10/16/12 stated Consider dose reduction or drug holiday . It was not until 10/22/12 that the dosage of [MEDICATION NAME] was reduced to 0.25 mg every morning, over two months after the initial recommendation. During the period from initial request to dose reduction, there was no evidence to suggest the reduction was contraindicated. In fact, according to Psychoactive medication monthly flow record for August 2012 through October 2012, no behaviors were documented by nursing. A staff interview was performed on 12/4/12 at 4:00 p.m. with Staff Pharmacist who verified accuracy of all information. In addition, an order was in place for [MEDICATION NAME] suppositories 25 mg 1 PR {per rectum} every 6 hours prn {as needed}. Nausea . This order was dated 8/4/12. I had not been administered during October or November, 2012. No stop date was listed. As per facility policy and procedure, all as needed medications not used in past sixty (60) days are to be discontinued. c.) Resident #3 [MEDICATION NAME] 25 mg twice a day was among the list of medications ordered for Resident #3 upon admission 2/22/12. It was not until 8/14/12 when Pharmacy first addressed [MEDICATION NAME] and stated it was still appropriate as Resident #3 was having hallucinations. On 10/11/12 pharmacy made a recommendation for the physician to try and taper the [MEDICATION NAME]. On 10/24/12 the physician completely discontinued the [MEDICATION NAME]. On 10/25 there was a physician's order [REDACTED]. This was discussed and verified with the Pharmacist on 12/4/12 at 4 p.m. In addition, Resident #3 had physician orders [REDACTED]. There is no order to specify under what situation the nurse should apply Preparation H and when to apply the [MEDICATION NAME]. The Preparation H order is incomplete and does not include a site where to apply, nor does it have a stop date. The original order was written 9/9/2005. The [MEDICATION NAME] order also does not have a stop date and is dated 4/1/2009. An order dated 3/1/11 stated [MEDICATION NAME] Cream to vaginal area and labia PRN {as needed} . This order has no stop date and gives no indication as to what symptoms constitute as needed . These orders were discussed with the DON on 12/5/12 at 2:30 p.m. and she had no further information. The policy clearly states that all as needed medications not used in sixty (60) days will be discontinued. According to the Medication Administration Record [REDACTED]. d) Resident #2 Review of the medical record on 12/06/12 revealed the following prn medications: [REDACTED]. [MEDICATION NAME] 4 mg was administered once between 08/01/12 and 11/30/12 on 09/29/12 and currently remains on the residents MAR indicated [REDACTED] The pharmacy reconciliation notes dated 01/12/12 through 12/04/12 verifies the pharmacist failed to recognize and notify the physician to discontinue prn medications which were not used for 60 days as the policy states. During a staff interview on 12/06/12 at 9:30 a.m. with the Director of Nursing (DON) employee #11 she acknowledged they were not following the facility's policy which is to automatically stop prn medications after thirty (30) days. The pharmacy policy received on 12/06/12 at 10:27 a.m. from the DON employee #11, states All new medication orders are subject to automatic stop orders unless the medication orders specify the number of doses or duration of medication. A time limit is included in recapped orders. All prn medication orders, except for [MEDICATION NAME], are discontinued in 60 days if not utilized at all during that time, unless the prescriber specifically orders them to be continued indefinitely or for a special period of time. 2016-05-01