| 42 |
GRANITE REHABILITATION AND WELLNESS |
535013 |
3128 BOXELDER DRIVE |
CHEYENNE |
WY |
82001 |
2018-10-12 |
758 |
D |
0 |
1 |
P2JJ11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and policy and procedure review, the facility failed to ensure appropriate medication use for 2 of 5 sample residents (#62, #81) reviewed for [MEDICAL CONDITION] medications. The findings were: 1. Review of the significant change MDS assessment date 8/4/18 showed resident #62 had [DIAGNOSES REDACTED]. Further review showed the resident rejected care and wandered 1 to 3 days during the look back period. Review of the depression and anxiety care plan last revised on 5/21/18 showed interventions included Administer medications as ordered, monitor/document for side effects and effectiveness .Monitor/document/report PRN (as needed) any risk for harm to self: suicidal plan, past attempt at suicide, risky actions (stockpiling pills, saying goodbye to family, giving away possessions or writing a note), intentionally harmed or tried to harm self, refusing to eat or drink, refusing med or therapies, sense of hopelessness, impaired judgement or safety awareness. Monitor/document/report PRN any s/sx (signs or symptoms) of depression, including: hopelessness, anxiety, sadness, [MEDICAL CONDITION], anorexia, verbalizing, (sic) negative statements, repetitive anxious or health-related complaints, tearfulness. Monitor/record/report to MD prn risk for harming others: increased anger, labile mood or agitation, feels threatened by others or thoughts of harming someone, possession of weapons or objects that could be used as weapons . Review of the Medication Administration Record [REDACTED]. The following concerns were identified: a. Review of a Behavior Monitoring Flowsheet dated 10/2018 showed the monitored behavior was aggression directed at others, the identified trigger was Dx (diagnosis) of dementia, and interventions included 1. Redirect as able 2. Offer (him/her) something to hold onto 3. Involve family 4. R/O (rule out) unmet needs. Further review showed the monitoring did not include specific target behaviors identified for the use of individual medications and did not include specific target behaviors identified on the resident's care plan. 2. Review of the significant change MDS assessment dated [DATE] showed resident #81 had [DIAGNOSES REDACTED]. Further review showed the resident had physical behavioral symptoms directed at other on 4 to 6 days and verbal behavioral symptoms directed towards others on 1 to 3 days during the look back period. Review of the depression care plan last revised on 6/3/18 showed interventions which included .Monitor/document/report PRN any s/sx of depression, including: hopelessness, anxiety, sadness, [MEDICAL CONDITION], anorexia, verbalizing, (sic) negative statements, repetitive anxious or health-related complaints, tearfulness . Review of the mood problem care plan last revised on 9/17/18 showed .Anticipate (resident's name) impulsive behavior and attempt to keep others at least an arm length's away .Monitor for signs of increased anxiety, change in mood, aggression,. Keep (him/her) away from other residents during those times .(resident's name) can be intrusive and wander into others personal space and room .(resident's name) can be resistive to care-hit, kick, and throw items. Offer reassurance, take to quiet area . Review of the MAR for (MONTH) (YEAR) showed the resident received duloxetine [MEDICATION NAME] (antidepressant) 60 mg capsule by mouth in the morning for major [MEDICAL CONDITION], [MEDICATION NAME] (anti-anxiety) [MEDICATION NAME] ([MEDICATION NAME]) [MEDICATION NAME] (antipsychotic) [MEDICATION NAME] (anti-emetic) (ABHR) gel 1 ml (milliliter) [MEDICATION NAME] on the wrists every morning and at bedtime for pain/aggression, and [MEDICATION NAME] (antipsychotic) 0.25 mg by mouth at bedtime. The following concerns were identified: a. Review of a Behavior Monitoring Flowsheet dated 10/2018 showed the monitored behavior was aggression directed at others, the identified trigger was 1. Dx of dementia 2. DX of depression 3. Over stimulation, and interventions included 1. Redirect as able 2. Involve family 3. 1:1 conversation 4. R/O (rule out) unmet needs. Further review showed the monitoring did not include specific target behaviors identified for the use of individual medications and did not include specific target behaviors identified on the resident's care plan. 3. Interview with the DON on 10/12/18 at 9:15 AM confirmed the behavior monitoring did not identify specific behaviors for individual medications, the behaviors on the care plan did not match the behaviors the facility was monitoring for medication use, and the rational for effectiveness of medications could not be determined from the behavior monitoring. 4. Review of the policy titled Behavior Management last revised 10/2017 showed .5. If a resident exhibits a new behavior symptom, staff implements the Behavior Monitor Flowsheet and notifies Social Services Director (SSD) and the IDT via the 24-hour Report. 6. The Behavior Monitor Flowsheet (number of behaviors, trigger, intervention, and outcome) is completed as the indicated behaviors are exhibited. 7. The IDT reviews the resident's record and Behavior Monitoring Flowsheet (as applicable) to evaluate whether the current plan is effective. If the plan is effective, the IDT makes a note in the medical record. If further evaluation is is needed, modification, including adding changes to care plan and Behavior Monitoring Flowsheet using non-medication interventions, are implemented . |
2020-09-01 |