cms_GU: 33
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 33 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 329 | D | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that each resident's drug regimen was free from unnecessary drugs. An unnecessary drug is any drug when used without adequate monitoring or without adequate indication for its use or in the presence of adverse consequences which indicate the dose should be reduced or discontinued, or any combinations of the reasons above. (Reference Residents 4 and 8) Findings include: 1. Resident 8 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. Review of the discharge summary from the hospital dated 5/17/16 revealed that the resident had a history of [REDACTED]. One of the discharge medications listed from the hospital was [MEDICATION NAME] (an antipsychotic drug) 1 milligram (mg.) three times a day as needed for agitation. Review of the initial admission minimum data set (MDS) - an assessment tool dated 5/24/16 revealed that the resident had short and long term memory problems, and that his cognitive skills for daily decision making was severely impaired. The resident had unclear speech and was rarely/never understood, however, he sometimes understands. He also had severely impaired vision and had no corrective lenses. The resident exhibited no mood or behavior problems. The resident was identified as totally dependent with one person physical assist for all activities of daily living (ADL). He was also noted as always incontinent of bowel and had an indwelling urinary catheter due to Stage IV pressure ulcer in the sacrum. He was admitted with multiple pressure ulcer acquired from home and had post debridement of the ulcer from the hospital. The latest quarterly MDS dated [DATE] revealed no significant change from the admission MDS. On 9/26/16 at 10:40 a.m., during the initial tour, Resident 8 was in bed and non-verbal and had an indwelling urinary catheter with clear urinary output. LN1 indicated that the resident was getting ready for discharge to home. The resident had a history of [REDACTED]. On the same day, 9/26/16, Resident 8's yelling was heard in the hallway and nurses station. Review of nurses notes dated 6/15/16 revealed that Resident 8 was agitated at 2:00 a.m., and that staff repositioned patient (pt.), offered milk and adjust lighting in room, still talking in loud voice, [MEDICATION NAME] 1 mg. po PRN given, with relief. pt able to sleep. On 7/6/16, the pharmacist's medication regimen review (MRR) revealed that the agitation/[MEDICAL CONDITION] medication, was dose appropriate for indication, behavior monitoring in MAR indicated [REDACTED]. The active medication order as of 7/6/16 was [MEDICATION NAME] ([MEDICATION NAME]) 1 mg. by mouth (po) three times a day (TID) as needed (PRN) for agitation. Gradual dose reduction (GDR) was recommended by the pharmacist and the physician agreed with the GDR to [MEDICATION NAME] 1 mg. po once daily (QD) PRN for agitation. On 8/18/16 the MRR revealed the GDR was complete to no active order. 1 dose since admit, continue behavior monitoring in Medication Administration Record [REDACTED]. On 9/26/16 the MRR timed at 8:02 a.m. revealed that GDR [MEDICATION NAME] was completed and the resident had no active order for [MEDICAL CONDITION] medications. Care conference was scheduled for next week for discharge planning. Review of the pharmacy notes dated 9/26/16 revealed that the resident had a history of [REDACTED]. po TID PRN on admission, and history of behavioral health patient. The GDR for [MEDICATION NAME] was completed on 8/18/16 and no active order since then. Recent episodes last 3 days shouting, agitation (see MAR behavior monitoring), non-pharmacological measures attempted - food, fluids, change position. Continue behavior/intervention monthly flow record in MAR, goal- positive outcomes with non-pharmacological interventions, medication secondary intervention, no history of dementia documented. [MEDICATION NAME] 1 mg. po QD PRN agitation - new order obtained on 9/26/16. Assessment/Plan: Agitation becoming more frequent, recommended put [MEDICATION NAME] back on order for [MEDICATION NAME] 1 mg. po daily PRN agitation. Continue monitoring with appropriate tracking in MAR indicated [REDACTED]. Review of the Behavior/Intervention Monthly Flow Record for (MONTH) (YEAR) revealed the behavior monitored for [MEDICATION NAME] administration was agitation. The record also revealed that the listed behaviors with asterisk sign (*) were behaviors which by themselves don't justify antipsychotic (AP) drugs. One of the specific behaviors listed was #2. agitated On 9/28/16 at 9:00 a.m., interview with the pharmacist revealed that facility staff had been monitoring the resident's agitated behavior since the resident was admitted with prescribed [MEDICATION NAME]. She confirmed that there were no specific agitated behaviors exclusively identified as manifested by Resident 8. Interview with the resident's caregiver revealed that the resident was non-verbal when he was admitted and now he started yelling again. Interview with LN1 revealed that they have noted the increase in yelling episodes after the discharge plan was initiated by the the interdisciplinary (IDT) team. LN1 confirmed that the resident was initially non-verbal and started talking in loud voice and had episodes of yelling for three days. However, LN1 acknowledged that IDT should have looked closely at the reason for resident's yelling than putting him back on [MEDICATION NAME] PRN medication for agitation. 2. Resident 4 was admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. Review of Resident 4's latest quarterly Minimum Data Set (MDS) - assessment tool dated 7/02/16 revealed the resident had a brief interview of mental status score (BIMS) of 9 indicating moderate impairment of cognitive skills. The resident mood interview revealed that the resident was feeling down, depressed, or hopeless for several days. Also the resident exhibited verbal behavioral symptoms directed toward others that occurred 4-6 days. The resident also exhibited rejection of care for 4 to 6 days. The depressed behaviors and refusal of care at intervals were confirmed by LN1 during the initial tour of the facility on 9/26/16 at 10:40 a.m. On 9/26/16 at 2:30 p.m., during an interview, Resident 4 stated that he wanted to talk to his ex-wife to discuss about the pending surgery to amputate the gangrenous left foot. Review of the physician's orders [REDACTED]. Review of the behavior/intervention monthly flow record for (MONTH) (YEAR) revealed depression as behavior being monitored for [MEDICATION NAME] 50 mg. po. daily. This record also revealed that the listed behaviors with asterisk sign (*) were behaviors which by themselves don't justify antipsychotic (AP) drugs. One of the specific behaviors listed was #12. Depressed/withdrawn On 9/26/16 at 10:45 a.m. LN1 confirmed the resident's depressed behavior but was unable to provide the specific behavioral manifestations of Resident 4's depressed status that needed to be monitored quantitatively in the behavior flow record. Although the flow record provided the potential side effects of the general drug category such as antidepressant, the flow record did not indicate the potential side effects of a specific classification of antidepressant such as [MEDICATION NAME] that was classified as a selective serotonin reuptake inhibitor (SSRI), and any information related to the black box warning. According to the manufacturer's information regarding antidepressants and suicidality (Labeling/Pfizer.com) patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Review of the resident's care plan dated 9/12/16 revealed a problem of [MEDICAL CONDITION] drug use with outcome: Patient will be free of complications associated with [MEDICAL CONDITION] drug use. Interventions included: assess and record benefit side effects, drug related complications, or drug related cognitive-behavior or impairment; assess for drug related gait disturbances, drug related [MEDICAL CONDITION], or movement disorder; assess need of continued potential use for less restrictive alternative approach. The plan of care was generalized for [MEDICAL CONDITION] drugs and not specific to the antidepressant that was newly prescribed for Resident 4. | 2020-09-01 |