cms_AK: 16

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.

Data source: Big Local News · About: big-local-datasette

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rowid facility_name facility_id address city state zip inspection_date deficiency_tag scope_severity complaint standard eventid inspection_text filedate
16 KETCHIKAN MED CTR NEW HORIZONS TRANSITIONAL CARE 25010 3100 TONGASS AVENUE KETCHIKAN AK 99901 2018-08-03 758 D 0 1 RHGS11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and policy review the facility failed to ensure 1) PRN (as needed) [MEDICAL CONDITION] (any drug capable of affecting the mind, emotions, and behavior) medication was limited to a 14 day duration in compliance with federal regulation and 2) was re-evaluated by a physician with appropriate documentation for continued use in 2 residents (#5 & #14), out of 6 sampled residents. This failed practice placed the residents at risk for receiving unnecessary medication and for experiencing potentially severe and debilitating side effects of [MEDICAL CONDITION] medication. Findings: Resident #5 Record review on 8/1/18 of Resident #5 most recent MDS (Minimum Data Set-a federally required nursing assessment), a significant change assessment dated [DATE], revealed [DIAGNOSES REDACTED]. Review of Resident #5's Medication Administration Record [REDACTED]. Further review revealed this medication started on 11/29/17 with an end date of 11/29/18 (a 1 year order). [MEDICATION NAME] is a medication used to relieve anxiety. Review of Resident #5's medication administration history revealed the following PRN use for anxiety: - (MONTH) (YEAR): 5 doses received - (MONTH) (YEAR): 8 doses received - (MONTH) (YEAR): 5 doses received - (MONTH) (YEAR): 5 doses received - (MONTH) (YEAR): 6 doses received - (MONTH) (YEAR): 3 doses received - (MONTH) (YEAR): 2 doses received Additional review of the MAR indicated [REDACTED]. Review of the physician's notes, dated 12/1/17, 2/5/18, 4/2/18, and 6/4/18, revealed no documentation of the number of times [MEDICATION NAME] PRN was used, or the efficacy of the [MEDICATION NAME] PRN use. Further review revealed no documentation of a possible dosage reduction or projected duration of [MEDICATION NAME] PRN use. Review of the Pharmacist's 30 day Drug Regimen Reviews, dates (MONTH) (YEAR) through (MONTH) (YEAR), revealed no recommendation on the [MEDICATION NAME] PRN use, nor any recommendation to attempt a dosage reduction or elimination. Review of Quarterly Team Conference notes, dated 10/19/17 and 1/11/18, revealed no documentation of [MEDICAL CONDITION] PRN drug use for anxiety: BEHAVIORAL SYMPTOMS: None. Further review revealed no discussion on possible reduction or elimination of the medication. Review of the Annual Team Conference note, dated 4/17/18, revealed no documentation of [MEDICAL CONDITION] PRN drug use for anxiety: BEHAVIORAL SYMPTOMS: None. Further review revealed no discussion on possible reduction or elimination of the medication. Resident #14 Review of Resident #14 most recent MDS, an annual assessment dated [DATE], revealed [DIAGNOSES REDACTED]. Review of Resident #14's MAR indicated [REDACTED]. Further review revealed this medication started on 1/30/18, with an end date of 7/29/18 (a 6 month order). Review of Resident #14's medication administration history revealed the following PRN use for anxiety: - (MONTH) (YEAR): 2 doses received - (MONTH) (YEAR): 11 doses received - (MONTH) (YEAR): 14 doses received - (MONTH) (YEAR): 13 doses received - (MONTH) (YEAR): 15 doses received - (MONTH) (YEAR): 11 doses received - (MONTH) (YEAR): 14 doses received Review of the Physician's Progress notes, dated 2/12/18, 4/9/18, 5/31/18, and 7/27/18, revealed no assessment of anxiety, the number of times [MEDICATION NAME] PRN was used, or the efficacy of [MEDICATION NAME] PRN use. Further review revealed no documentation of a possible dosage reduction or projected duration of [MEDICATION NAME] PRN use. Review of the Pharmacist's 30 day Drug Regimen Reviews, dates (MONTH) through (MONTH) (YEAR), revealed no recommendation on [MEDICATION NAME] PRN use, nor any recommendation to attempt a dosage reduction or elimination. Review of Quarterly Team Conference notes, dated 10/24/17, 1/23/18, and 4/12/18, revealed no documentation of [MEDICAL CONDITION] PRN drug use for anxiety: BEHAVIORAL SYMPTOMS: None. Further review revealed no discussion on possible reduction or elimination of the medication. Review of the Annual Team Conference note, dated 7/17/18, revealed no documentation of [MEDICAL CONDITION] PRN drug use for anxiety: BEHAVIORAL SYMPTOMS: None. Further review revealed no discussion on possible reduction or elimination of the medication. During an interview on 8/2/18 at 11:20 am, Pharmacist (RPH) #1 stated only antipsychotic (medication used to treat delusions, hallucinations, paranoia, or disordered thoughts) medication needed a 14 day limit on orders. When regulation was reviewed with RPH #1, he/she stated he/she missed this and was not monitoring for this limitation. During an interview on 8/2/18 at 11:20 am, Medical Director (MD) #1 stated the only protocol in place for [MEDICAL CONDITION] PRNs was they were to be re-evaluated every 6 months. He/she was unaware of the 14 day limit on [MEDICAL CONDITION] PRN use. Review of facility's policy Pharmacy Medication Reviews for (Long Term Care) Patients, dated 6/1/18, revealed no monitoring for [MEDICAL CONDITION] PRN orders to be limited to 14 days, unless specific documentation from the attending physician is present within the resident's medical record. Review of the facility's policy Psychotherapeutic Medications, dated 8/1/14, revealed: Procedure: Attending Medical Staff: c. if the provider determines that it is clinically contraindicated for the psychotherapeutic medication therapy dose to be tapered or discontinued, they must document the reason in the resident's medical record. Further review revealed: e. 1. PRN orders for [MEDICAL CONDITION] drugs are limited to 14 days. 2. if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order. 2020-09-01