cms_AL: 67

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

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
67	MERRY WOOD LODGE	15019	P O BOX 130	ELMORE	AL	36025	2020-03-03	756	D	1	1	LZCS11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY > Based on record review, interviews, review of the consultant pharmacist's February 2020 Medication Regimen Review reports, and review of policies titled 9.1 Medication Regimen Review and 3.8 [MEDICAL CONDITION] Medication Use, the facility failed to ensure the consultant pharmacist identified concerns during the February 2020 medication review with Resident Identifier (RI) #24's [MEDICATION NAME], an antipsychotic medication, that was ordered on [DATE] without adequate justification for use. This affected RI #24, one of six sampled residents reviewed for unnecessary medications. Findings include: Review of the policy titled 9.1 Medication Regimen Review, dated 11/28/16, revealed the following: .PROCEDURE . 1.1 The drug regimen of each skilled nursing facility resident must be reviewed at least once a month by a licensed pharmacist. Review of the policy titled 3.8 [MEDICAL CONDITION] Medication Use, revised 11/28/16, revealed the following: POLICY This Policy 3.8 sets forth procedures relating to [MEDICAL CONDITION] medication use. DEFINITION A [MEDICAL CONDITION] drug is any medication that affects brain activities associated with mental processes and behavior, PROCEDURE . 8. Antipsychotic medications used to treat Behavioral or Psychological Symptoms of Dementia (BPSD) must be clinically indicated, be supported by an adequate rationale for use, and may not be used for a behavior with an unidentified cause. RI #24 was originally admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. Review of hospital records indicated RI #24 was transferred to the hospital on [DATE] due to complaints of chest pain, where he/she remained overnight until readmitted to the facility on [DATE]. Review of RI #24's current physician orders [REDACTED]. However, review of RI #24's order history, revealed RI #24 had not received [MEDICATION NAME] since the order was previously discontinued on 11/02/2018. Further, review of RI #24's current comprehensive care plans revealed no care plan for any behaviors. Review of the Pharmacy Consultation Reports indicated monthly Medication Regimen Reviews had been conducted from 2/16-2/18/20. RI #24's recommendation reports indicated the pharmacist had not identified a concern with the order for [MEDICATION NAME]. On 3/03/20 at 3:18 PM, a consultant Pharmacist (Pharmacist #1) was asked to explain the [MEDICAL CONDITION] Medication Use policy and the reference to a clinically indicated use and rationale. Pharmacist #1 stated there were a number of psychiatric disorders, as well as behaviors with intention for harm, that would warrant the use of antipsychotic medication. Pharmacist #1 stated he had not reviewed the policy in some time and did not realize it was so vague. When asked about [MEDICATION NAME] and whether Dementia or Alzheimer's would be an appropriate [DIAGNOSES REDACTED].#1 said no, unless there were documented behaviors or other diagnoses. Pharmacist #1 stated he filled orders for medications, but Pharmacist #2 was in the facility each month to conduct the medication reviews. Pharmacist #2 was interviewed on 3/03/2020 at 3:35 PM. Pharmacist #2 stated RI #24 had been prescribed [MEDICATION NAME] once daily for Alzheimer's. When asked what types of [DIAGNOSES REDACTED].#2 said dementia with associated behaviors. He further stated Alzheimer's was not the best [DIAGNOSES REDACTED].#24's [MEDICATION NAME]. After reviewing the information he had available on RI #24, Pharmacist #2 said he had notes indicating he had recommended a dose reduction on RI #24's [MEDICATION NAME] on 7/2/18 and it had been completely discontinued as of his note on 12/4/18. Pharmacist #2 also indicated another pharmacist (Pharmacist #3) made a note on 1/28/2020 that indicated RI #24 was receiving [MEDICATION NAME] 25 mg daily for Dementia. When asked what was an adequate rationale for use of an antipsychotic, Pharmacist #2 said [MEDICAL CONDITION]'s, [MEDICAL CONDITION], or Dementia with behaviors; He further stated dementia without behaviors would not be a reason to warrant use of [MEDICATION NAME]. As far as making a recommendation regarding the rationale and [DIAGNOSES REDACTED].#24's [MEDICATION NAME], Pharmacist #2 said he must have missed it when doing his February 2020 review.	2020-09-01