| 100 |
ST JOHN'S LUTHERAN HOME |
275024 |
3940 RIMROCK RD |
BILLINGS |
MT |
59102 |
2017-11-08 |
329 |
D |
0 |
1 |
8YVD11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to attempt a dose reduction for an antipsychotic and an antianxiety medication for 2 (#s 10 and 12) of 25 sampled residents. Findings include: 1. Review of resident #12's Quarterly MDS, with the ARD of 8/23/17, showed the resident had a [DIAGNOSES REDACTED]. Review of resident #12's Care Plan, initiated 4/4/16, showed a problem for Thought process related to dementia, [MEDICAL CONDITION] with use of [MEDICAL CONDITION] medication, history of chronic pain that can affect thought process, depression, [MEDICAL CONDITION]. The goals included I will be oriented to self daily by responding to my name - by looking at the speaker. The goals and interventions had not been updated since 4/4/16. During an interview and observation on 11/7/17 at 3:30 p.m., resident #12 was alert and oriented, able to respond to all questions, and was friendly and pleasant. Review of resident #12's certification visit by the physician, dated 6/23/16, showed Patient's baseline behavior has improved. He has been receiving [MEDICATION NAME] XR 50 mg (antipsychotic) twice a day. He has been tired in the mornings, most likely due to his [MEDICATION NAME] dose. I'm discontinuing the morning dose keeping [MEDICATION NAME] 50 mg XR daily at 1600. Review of resident #12's Social Service note dated 8/29/17, showed (Resident's) depression score is related to his experienced pain. (Resident) is very independent and travels in the community without assistance. He states that he does worry about falling and hurting himself. (Resident's) memory is good and he has good problem solving capability, if he is not in pain. Pain does cloud his judgement. (Resident) is social and has many friends in the facility. Review of a Pharmacy Note, dated 5/11/17, showed Resident receiving [MEDICATION NAME] at bedtime for [MEDICAL CONDITION]. No mood or behavior documented this review period. Review of a Pharmacy Note, dated 7/18/17, showed Resident stable. No [MEDICAL CONDITION] noted. Resident has failed reduction in the past. Review of a Pharmacy Note, dated 8/29/17, showed Gradual Dose reduction declined by provider due to previously failed attempt. Review of a Pharmacy Note, dated 10/24/17, showed Caretracker showed no mood or behavior indicators. Provider declined GDR of [MEDICATION NAME] (10/10/17) due to previously failed attempt. During an interview on 11/7/17 at 3:45 p.m., staff member G stated no GDR's were attempted for resident #12 since his arrival to the unit, in April, (YEAR). Record review showed the reduction in [MEDICATION NAME] occurred on 4/23/16, and was successful. 2. Review of resident #10's Physician orders, dated 11/7/17, showed the resident was receiving [MEDICATION NAME] (anti-anxiety), routinely, twice a day. Review of resident #10's Care Plan, dated 5/5/16, showed a problem for dementia, thought process, and depression with anxiety. The interventions had not been updated since 5/5/16. Review of a Pharmacy Note, dated 7/10/17, showed the resident failed a dose reduction of the [MEDICATION NAME] 11/2016. Review of resident #10's Physician visit, dated 12/5/16, showed She recently had her [MEDICATION NAME] decreased to once a day. Nursing staff report that she was more irritable and would pick on other residents with this decrease. Therefore, her [MEDICATION NAME] was increased back to twice a day. Review of resident #10's Pharmacy Note, dated 10/2/17, showed Please evaluate [MEDICATION NAME] and [MEDICATION NAME] for dosing appropriateness, including rationale if no dose reduction attempted at this time. Record review showed no dose reduction occurred for the antianxiety medication [MEDICATION NAME] or the [MEDICATION NAME], for 2 years. Review of resident #10's Behaviors and Behavior Management forms, showed behaviors of agitation and hitting occurred on 10/31/16, 10/30/17, 1/20/17 and 4/5/17. During an interview on 11/8/17 at 9:05 a.m., staff member H stated the facility had addressed the medication as a possible contributing factor to resident #10's falls, but did not attempt to reduce or eliminate the medication. She said the facility could not override the doctor. |
2020-09-01 |