cms_HI: 11

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
11	HILO MEDICAL CENTER	125002	1190 WAIANUENUE AVENUE	HILO	HI	96720	2019-12-20	684	D	0	1	P3CE11	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview with resident and staff member, the facility failed to provide a bowel regimen for a resident to address constipation related to the routine and pro re nata (prn) use of opioid medication for pain management for 1 (Resident 18) of 1 residents sampled. Findings include: On 12/17/19 at 02:07 PM, an interview was conducted with Resident (R)18. R18 was asked whether he/she has constipation, R18 responded that he/she takes pain medication which results in constipation. R18 confirmed that sometimes he/she will go without a bowel movement for more than three days. Initially, R18 reported that he/she fixes it on his/her own; however, later reported that medication is provided. On 12/18/19 at 02:58 PM, a record review was done. R18 was admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. A review of the annual Minimum Data Set with assessment reference date of 10/28/19 documents R18 yielded a score of 15 (cognitively intact) upon administration of the Brief Interview for Mental Status. R18 requires extensive assist with one personal physical assist for toilet use. The resident is continent of bowel and bladder. R18 was not coded for constipation. In the medication section, R18 was documented as receiving opioid medications for pain daily in the last seven days. A review of the physician's orders [REDACTED]. every morning; [MEDICATION NAME] powder, 17 gm every 48 hours as needed for constipation with a start date of 10/16/19; [MEDICATION NAME] HCI, 5 mg every four hours for pain, prn; [MEDICATION NAME] HCI, 10 mg every four hours for pain, prn; and routine [MEDICATION NAME] HCI 10 mg. twice a day at 08:00 AM and 05:00 PM. Further review of the facility's intake and output log found the tracking in the electronic health record (EHR) which documents the following: continent of bowel movement (#); incontinent of bowel movement (#); and bowel movements (#). The EHR documents R18 did not have bowel movement from 12/04/19 through 12/06/19. R18 was documented with 0 (zero) for continent of bowel movement and incontinent of bowel movement and no documentation for number of bowel movement. A request was made to review the resident's frequency of bowel movement. The facility provided a vertical report entitled Continent of BM (#). The review found R18 did not have bowel movement from 11/19/19 through 11/20/19; 11/28/19 through 11/29/19; and 12/09/19 through 12/10/19. This report did not indicate R18 did not have a bowel movement from 12/04/19 through 12/06/19, it is documented R18 was continent of bowel movement under the heading of result as 1 (one). The intake and output documented in the EHR did not match the filtered report provided by the facility. On 12/19/19 at 01:15 PM, an interview was conducted with Licensed Nurse (LN)6. Inquired when is the prn of [MEDICATION NAME] for constipation is provided. LN6 responded when the resident does not have a bowel movement on the second day. LN6 further clarified the nurses keep track of residents' bowel movement by shift reports. A review of the physician order [REDACTED]. On 12/19/19 at 02:53 PM, an interview was conducted with the Director of Nursing (DON) and Resident Assessment Coordinator (RAC). A review of the documentation provided by the facility confirmed the aforementioned time periods when the resident did not have a bowel movement. Requested documentation that a prn of [MEDICATION NAME] powder was provided. There was no documentation of administration of [MEDICATION NAME]. The RAC reported, the resident may have refused the prn. Further requested documentation of the refusal. The RAC confirmed there is no documentation of resident's refusal for prn of [MEDICATION NAME] during the aforementioned periods.	2020-09-01