cms_AK: 67
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 67 | WRANGELL MEDICAL CENTER LTC | 25015 | P.O. BOX 1081 | WRANGELL | AK | 99929 | 2018-04-30 | 756 | E | 0 | 1 | O8F911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure: 1) the pharmacist had access to the complete medical record (#9); 2) the pharmacist noted and reported unnecessary medications for two residents (#s 2 and 10); and 3) policies and procedures were developed and maintained for the monthly drug regimen reviews that included time frames for the different steps in the process and steps the pharmacist must take when he or she identifies an irregularity that requires urgent action to protect the resident. These failed practices placed 1 resident (#9) at risk for ineffective medication management; 2 residents (#s 2 and 10) at risk for receiving unnecessary medication (based on a sample of 8) and placed all residents (based on a census of 10) at risk for delay in review of their current drug regimen reviews. Findings: Resident #9 Record review on 4/24-27/18, revealed Resident #9 was admitted to the facility with [DIAGNOSES REDACTED]. Review of the Medication Administration Record [REDACTED].) Review of the Drug Regimen Review (DRR), dated 12/17/17, revealed Resident #9 had a dosage change in (MONTH) (YEAR) to [MEDICATION NAME] 1mg by mouth HS (evening time). Further review of Resident #9's medical record revealed multiple month behavior logs and AIMS assessments (Abnormal Involuntary Movement Scale-a screening tool used to identify movements in people taking antipsychotic medications) in the medical record from (MONTH) (YEAR) to (MONTH) (YEAR). Review of monthly DRR in Resident #9's medical record from (MONTH) (YEAR) to (MONTH) (YEAR), revealed no comments by the Pharmacist to verify review of AIMS assessments and behavior logs. During an interview on 4/27/18 at 11:00 am, the Pharmacist stated AIMS assessments and behavior logs were not looked at for DRR. The Pharmacist further stated they do not have access to those documents for review. These documents should be part of the Pharmacist review for Residents taking medications that stabilize mood, control behaviors, and monitor for severe side effects from antipsychotic medication. Resident #2 Record review on 4/23-27/18 revealed Resident #2 was admitted to the facility with a [DIAGNOSES REDACTED]. Review on 4/26/18 at 7:15 pm of the physician orders [REDACTED]. Review of Resident #2's MAR for (MONTH) (YEAR), (MONTH) (YEAR), (MONTH) (YEAR) and (MONTH) (YEAR) revealed [MEDICATION NAME] had not been administered during these months. Review on 4/26/18 at 6:45 pm, of the monthly pharmacist DRR dated (MONTH) (YEAR) through (MONTH) (YEAR), revealed, under the resident medication listing no [MEDICATION NAME] used for the months of July, August, September, November, January, (MONTH) and use was not addressed for the months (MONTH) and March. Further review revealed the Pharmacist had not documented recommendations to the physician on any of the DRRs that [MEDICATION NAME] had not been administered for an extended period and possible consideration for discontinuance. During an interview on 4/27/18 at 11:24 am, Pharmacist stated when asked about the nonuse of [MEDICATION NAME] I would just hope they (Physicians) would not order it if it wasn't being used. Review on 4/27/18 at 3:45 pm, of the facility policy LTC Medication/Treatment Discontinuation, revision date 11/2016, revealed When prescription medications or treatments that are PRN are found that have not been used in the previous 90-days, they will be discontinued . Resident #10 Record review on 4/23-27/18, revealed Resident #10 was admitted to facility with [DIAGNOSES REDACTED]. Medication: [MEDICATION NAME] ([MEDICAL CONDITION] medication) Review of Resident #10's medical record revealed physician's orders [REDACTED]. - 10/2/17 - Give [MEDICATION NAME] 1gram (three times a day) (for) 7 days followed by 500mg (twice a day) until discontinued. - 12/19/17 - Increase [MEDICATION NAME] to 1,000mg (by mouth) (twice a day) unitl [MEDICAL CONDITION] clear. - 2/1/18 - (Discontinue) [MEDICATION NAME]. Review of Resident #10's lab work did not reveal any diagnostic confirmation of [MEDICAL CONDITION] Simplex Virus (HSV-virus that can cause shingles). Physician ordered a [MEDICAL CONDITION] culture on 1/5/18 which had negative results for HSV. Review of Resident #10's DRR revealed no review was completed for (MONTH) (YEAR). In addition, the DRR for (MONTH) (YEAR) and (MONTH) (YEAR) listed [MEDICATION NAME] on Resident #10's drug regimen. Resident #10 was not on Valacylovir during the review period of (MONTH) and (MONTH) of (YEAR). During an interview on 4/27/18 at 11:05 am, the Pharmacist stated the facility did not follow up on the [MEDICATION NAME] medication order. The Pharmacist further stated the pharmacy department did not complete a DRR for (MONTH) (YEAR). In addition, the Pharmacist also stated the DRR for (MONTH) (YEAR) and (MONTH) (YEAR) did not accurately reflect the correct regimen at the time of review. Medication: [MEDICATION NAME] (Antibiotic) Review of Resident #10's medical records revealed admission orders [REDACTED]. [MEDICATION NAME] was started on 10/2/17 after lab work indicated a urinary tract infection [MEDICAL CONDITION]. [MEDICATION NAME] was restarted on 10/31/17, rationale UTI (urinary tract infection) for 7 days. Review of Resident #10's physician notes and nursing notes from 10/24/17 to 10/31/18 did not reveal symptoms of UTI. Review of Resident #10's physician note, dated 10/31/17, revealed Functional incontinence with chronic Foley as well as recurrent colonization versus UTI again showing colonization or UTI and will treat with [MEDICATION NAME] 500mg twice a day x 7 days. Review of Resident #10's lab work from 10/2/18 to 4/26/18, revealed 1 UA dated 10/2/17. During an interview on 4/27/18 at 11:00 am, the Lab Director confirmed that only 1 UA, dated 10/2/17, and 1 culture and sensitivity, dated 10/3/17, was performed. During an interview on 4/27/18 at 11:05 am, Pharmacist stated there was no review by pharmacist completed on the event occurring on 10/31/17 to support second antibiotic use. Policy Review During random interviews on 4/26-27/18, when asked for a DRR policy, the CNO stated there was no specific policy related to DRR but provided a policy entitled Pharmacist Duties and Responsibilities. Review of the facility's policy entitled Pharmacist Duties and Responsibilities, dated 8/2016, revealed no established policy for the time frames for the different steps in the process and steps the pharmacist must take when he or she identifies an irregularity that requires urgent action to protect the resident. Review of the facilities policy table of contents from 4/27-30/18, revealed no other specific policies related to the expectations and explanatory information regarding the DRRs. During an interview on 4/27/18 at 11:15 am, the Pharmacist stated it was the expectation of the pharmacist to conduct DRR every 30 days and make recommendations the physician. | 2020-09-01 |