cms_GU: 98
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 98 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2010-09-17 | 250 | D | 0 | 1 | 7DPX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 1 of three residents in the sample described as receiving psychoactive medications. Finding includes: 1. Resident 3 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the medical record revealed that the resident was admitted from the hospital where she was treated for [REDACTED]. The minimum data set ((MDS) dated [DATE] described the resident as having short-term memory problem, with moderately impaired cognitive skills for decision-making, and was dependent on staff for all activities of daily living (ADL). Review of the medical record revealed nurses notes that documented Resident 3 as being confused and "restless," including on 8/21/10, 8/29/10, 8/30/10, 9/01/10 and 9/02/10; as well as "yelling"and being "agitated" including on 8/16/10, 8/29/10 and 9/15/10. Review of the medical record revealed that on 8/15/10, physician's orders [REDACTED]. days." Review of the MAR (medication administration record) and nurses notes revealed that Resident 3 was given Haldol for the behaviors. Further record review however revealed that in light of this, there was no evidence of social services participation in assessing the underlying cause of the resident's agitation or restlessness and whether this could be eliminated or minimized. In addition, there was no documentation of social service involvement in the development of interventions to address the behavior or decrease their frequency without the use of antipsychotic drugs (or use of the least dose possible). While a social service summary dated 8/24/10 referenced the resident as being "sometimes confused," there was no mention of any of the behaviors manifested by Resident 3 requiring treatment with antipsychotic drugs. During the survey, Resident 3 was frequently heard calling out to staff for assistance to get out of bed or to the bathroom including on 9/15/10 at 1:30 p.m. when the she was heard from the hallway calling out "nurse ...nurse" repeatedly. When asked what she wanted, Resident 3 replied, "Help me up ...help me up. I want to go to the bathroom." At 3:30 p.m. on 9/15/10, Resident 3 was again observed calling out, "get me up ...I want to get up." At 10:35 a.m. on 9/16/10, the resident was heard, saying repeatedly, "I want to get up ...I want to get up." When asked what she wanted to do, the resident replied that she wanted to get out of bed. Review of nurses notes including on 8/21/10 revealed that Resident 3 was given Haldol because "she dangles her legs over the bed and attempts to get down." There was no documentation available to indicate why the resident wants to get out of bed and why this could not be accommodated by staff. Medical record review revealed the lack of contraindication to Resident 3's getting out of bed. 2. Resident 5 was admitted to the facility on [DATE] with the [DIAGNOSES REDACTED]. The resident's MDS dated [DATE] revealed the resident is awake, alert, and verbally responsive. A social services summary form dated 9/1/10 revealed that the social worker was informed by the facility's unit nursing supervisor that the resident is on "suicidal watch" The social worker met with the resident who assured her that she will not harm herself and that she was joking with one of the nurse aides that she will kill herself using the cord line in her room. The social worker noted the resident was emotional during the interview and she stated that she is depressed and she is concerned about her placement upon discharge. Interviews with direct care givers of the resident indicated that they are not aware that the resident is on suicidal watch. There was no thorough assessment and plan of care for a resident on "suicidal watch" specific to Resident 5. A review of the admission orders [REDACTED]. A patient note dated 9/6/10 stated, "Resident is being treated for [REDACTED]." A plan of care last updated on 8/31/10 indicated a mood state problem with a goal that the resident will have improved mood with an approach to encourage her to participate in diversional recreational activities for socialization with groups. The occupational therapy indicated that she had been involved in resident activities. However, neither of the activity staff acting as activity director had any documentation that the activities provided were designed to meet the interests of Resident 5 whose depressed mood has deteriorated to suicidal thoughts within one month period. A review of the physician's orders [REDACTED]. The MAR (medication administration record) for medications administered as needed only showed that Halcion 0.125 mg was given to Resident 5 on 9/3, 9/6 and 9/8 twice - at 0030 and 2100. Also Halcion 0.25 mg. was administered on 9/4, 9/5, 9/9, 9/10, 9/11, 9/12, 9/13, 9/14, 9/15, and 9/16/10. The medical record showed no documentation of non-drug intervention prior to administering a hypnotic. There was no documentation of attempts to determine the cause of Resident 5's inability to fall asleep without the use of hypnotic. | 2014-12-01 |