cms_ND: 52
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 52 | MINOT HEALTH AND REHAB, LLC | 355031 | 600 S MAIN ST | MINOT | ND | 58701 | 2019-06-11 | 658 | D | 1 | 0 | HFFF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > THIS IS A REPEAT DEFICIENCY FROM SURVEYS COMPLETED ON 08/16/18. MEDICATION ADMINISTRATION 1. Based on information received from the complainants, observation, review of facility policy, and staff interview, the facility failed to ensure staff followed professional standards of practice for 2 of 2 sampled residents (Resident #1 and #2) on insulin and 1 supplemental resident (Resident #20) observed during medication administration. Failure to follow physician's orders for Resident #1 and #2 and failure to ensure Resident #20 consumed his/her medication may result in adverse health consequences. Findings include: Information provided by the complainants indicated family members questioned nursing staff regarding changes in the residents' medication/treatment regimen. Review of facility policy titled Administering Medications occurred on 06/10/19. This policy, revised (MONTH) 2012, stated, Medications must be administered in accordance with the orders . If a dosage is believed to be inappropriate or excessive for a resident . contact the resident's Attending Physician . If a drug is withheld . update physician and family . Residents may self-administer their own medications only if the Attending Physician, in conjunction with the Interdisciplinary Care Planning Team, has determined that they have the decision-making capacity to do so safely. Review of facility policy titled Administering Oral Medications occurred on 06/10/19. This policy, revised (MONTH) 2010, stated, . Remain with the resident until all medication have been taken . - Review of Resident #1 occurred on all days of survey. Review of Resident #1's Medication Administration Record [REDACTED] * 04/14/19 at 7:36 a.m.: [MEDICATION NAME] Flex Pen . Inject 3 units . BS (blood sugar) 90, held per nursing judgement. * 04/22/19 at 7:16 a.m.: [MEDICATION NAME] Flex Pen . Inject 3 units . held BS 99, per nursing judgement. * 04/27/19 at 9:53 a.m.: [MEDICATION NAME] Flex Pen . Inject 3 units . held per nursing judgment, BS 85. * 05/11/19 at 10:25 a.m.: [MEDICATION NAME] Flex Pen . Inject 3 units . held per nursing judgement, BS 85. - Review of Resident #2 occurred on all days of survey. Review of Resident #2's medication administration documentation identified the following: * 03/10/19 at HS: (bedtime) [MEDICATION NAME] Flex Pen Solution . Inject 14 units . Resident ate less than 50% of supper. HS bs 115. [MEDICATION NAME] held. * 05/10/19 at 7:30 a.m.: [MEDICATION NAME] Flex Pen Solution . Inject 5 units . held per nursing judgement. BS 87. - During observation of the noon meal on 06/05/19 at 12:20 a.m., an unidentified nurse reported he/she dissolved Resident #20's medication in hot chocolate because the resident usually refuses medications. The nurse then handed the cup of hot chocolate to Resident #20, watched the resident take a couple swallows and left. Staff failed to observe the resident consume all the medication, failed to obtain physician orders to disguise medications and/or orders for resident to self medicate. During an interview on 06/06/19 at 10:43 a.m., an administrative nurse (#5) stated that he/she would expect staff to notify the physician if insulin is held and to stay with residents until all medication is consumed. INSULIN PREPARATION AND ADMINISTRATION 2. Based on information received from the complainants, observation, policy review, and review of manufacturer's guidelines, the facility failed to follow professional standards of practice when preparing and administering insulin for 2 of 4 observations of insulin administration. (Resident #5 and #8 ). Failure to cleanse the rubber [MEDICATION NAME] before applying a new needle, cleanse the injection site prior to administration, and failure to keep the needle inserted into the skin for at least 6 seconds may result in the resident receiving an infection and an inaccurate amount of insulin. Findings include: Information provided by the complainants indicated nursing staff failed to consistently cleanse the injection site prior to administering insulin. Review of the facility policy titled Insulin Administration occurred on 06/05/19. This policy, revised (MONTH) (YEAR), stated, . Remove the cap from the pen and wipe the rubber [MEDICATION NAME] with an alcohol wipe. Cleanse skin with an alcohol wipe using circular motion form (sic) the center of the chosen injection site until an area about three inches in diameter has been prepared. Keep the needle in the skin for up to 10 seconds. Review of manufacturer's guidelines for [MEDICATION NAME]stated, . Pull off the tamper resistant cap. Wipe the rubber [MEDICATION NAME] with an alcohol swab. Choose your injection site and wipe the skin with an alcohol swab. Insert the needle into your skin. Push down on the plunger to inject your dose. Needle should remain in the skin for at least 6 seconds to make sure you have injected all the insulin. - Observation on 06/05/19 at 8:40 a.m. showed a licensed nurse (#1) removed the cap from the insulin pen and placed a new needle without cleansing the rubber [MEDICATION NAME] with an alcohol swab. The nurse primed the insulin pen, dialed the correct dose, then administered the insulin to Resident #5 without cleansing the injection site prior to the injection. The nurse pushed down the plunger to administer the insulin, then removed the needle from the skin after 3 seconds. - Observation on 06/05/19 at 8:48 a.m. showed a licensed nurse (#1) removed the cap from the insulin pen and placed a new needle without cleansing the rubber [MEDICATION NAME] with an alcohol swab. The nurse primed the pen, dialed the correct dose, then administered the insulin to Resident #8 without cleansing the injection site prior to the injection. The nurse pushed down the plunger to administer the insulin, then removed the needle from the skin after 3 seconds. | 2020-09-01 |