cms_WV: 9508
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9508 | EMERITUS AT THE HERITAGE | 5.1e+153 | RT. 4, BOX 17 | BRIDGEPORT | WV | 26330 | 2011-06-22 | 329 | D | 0 | 1 | DLX411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure each resident's drug regimen is free from unnecessary drugs, as evidenced by: administering an excessive dose (duplicate therapy) of antianxiety medications for an excessive duration; continuing medications recommended by the pharmacist for either a dose reduction or discontinuation without a physician's rationale for risks versus benefits for continuing the medications; using an antipsychotic medication on a PRN (as needed) basis at bedtime for agitation; and failing to monitor [MEDICAL CONDITION] functioning of a resident receiving [MEDICAL CONDITION] medications. This practice affected three (3) of twenty-seven (27) Stage II sample residents. Resident identifiers: #33, #58, and #61. Facility census: 47. Findings include: a) Resident #33 2. Review of physician's orders [REDACTED]. Additionally, [MEDICATION NAME] (an antipsychotic medication) was increased to 5.0 mg twice daily beginning 01/21/11. Review of the pharmacist's Consultation Report dated 06/05/11 revealed a recommendation to consider a dose reduction for [MEDICATION NAME] (perhaps to 0.5 mg twice daily) and discontinuation of the [MEDICATION NAME] 25 mg twice daily. In reply, the physician on 06/08/11 wrote No changes and asked: Is this not the pt. (patient) that is beating up other residents?????? However, the physician provided no rationale as to why the two (2) antianxiety medications were continued. At this time, the resident also continued receiving [MEDICATION NAME] 5 mg twice daily and [MEDICATION NAME] 7.5 mg (an antidepressant) at bedtime. Review of the 23rd edition of Mosby's Nursing Drug Reference book (which was found at the facility's nurses' station) revealed a precaution for [MEDICATION NAME] use in geriatric patients, and cautioned that this medication was not to be used for everyday stress or used longer than four (4) months; potential central nervous system side effects include confusion and depression. Review of the Veteran's Administration (VA) clinic visit note dated 05/16/11 revealed it contained VA outpatient prescriptions for some medications, including [MEDICATION NAME] 25 mg, with orders to take one (1) capsule of [MEDICATION NAME] by mouth twice per day as needed for anxiety - and not twice daily as a scheduled medication. During an interview with the director of nursing (DON) on 06/22/10 at 10:10 a.m., she acknowledged that the targeted behavioral symptom(s) on the Psychoactive Medication Monthly Flow Record in April 2010 were for cursing and yelling (at others); in May 2011, it was was for yelling (at others); and there were no targeted behaviors listed for June 2011. The DON acknowledged that hitting others was a targeted behavior for him, although it was not listed on the Psychoactive Medication Flow Record. She stated that nurses are supposed to document behaviors on the Psychoactive Medication Monthly Flow Record, but they are allowed, per policy, to document the behaviors in the nurse's notes instead, and they should all know what the targeted behaviors are. - 2. Record review revealed Resident #33 was prescribed [MEDICATION NAME] 75 mcg daily for [MEDICAL CONDITION] beginning 12/10/10. Further record review found no evidence of [MEDICAL CONDITION] function monitoring during this resident's stay at the facility, nor for physician's orders [REDACTED]. During interview with the DON on 06/22/10 at 10:10 a.m., she said [MEDICAL CONDITION] testing results may be in the thinned record and she would look. The DON was unable to produce evidence of [MEDICAL CONDITION] monitoring prior to exit in the late afternoon on 06/22/11. -- b) Resident #58 Record review revealed a physician's orders [REDACTED]. Review of the Medication Administration Record [REDACTED]. Review of the back of the MAR found no documentation citing the reason for the administration of the [MEDICATION NAME] or for the results of its use. Further record review found no documentation in the nurses's notes about the administration of the [MEDICATION NAME] on 04/08/11, of the preceding events leading up to its use, of non-pharmacological interventions attempted before using the drug, or of the results of the drug intervention. During an interview with the DON on 06/22/11 at 10:10 a.m., she said nurses are supposed to document the behavior the resident exhibits, the events leading up to the behavior, any alternative methods attempted to treat the behaviors without medication, and the outcome. The DON said she would speak to the pharmacist related to a recommendation to discontinue the PRN [MEDICATION NAME], which had been used only once since ordered on [DATE]. -- c) Resident #61 The medical record of Resident #61, on 06/16/11, disclosed the resident was admitted to the facility on [DATE] following hospitalization . The resident's discharge summary from the hospital, which accompanied him upon admission to the facility, stated the resident had been admitted to the hospital from home due to confusion, weight loss, anorexia, headache, and [MEDICAL CONDITION]. The resident underwent [REDACTED]. This discharge document made mention that his [MEDICATION NAME] does was adjusted. The [MEDICATION NAME] dose at the time of discharge from the hospital was 0.125 mg daily and remained at that dose currently. There was no [MEDICAL CONDITION] function testing from the hospital on the resident's medical record at the facility. The resident's medical record was further reviewed, and there was no indication that [MEDICAL CONDITION] function testing had been completed since the time of his admission to the facility. The DON confirmed, on the afternoon of 06/16/11, that, in view of the fact that the resident had apparently undergone a dosage adjustment of this [MEDICAL CONDITION] medication shortly before arrival at the facility, a baseline level should have been obtained and that proper monitoring for the use of this medication had not been completed. | 2015-11-01 |