| 74 |
SANDIA RIDGE CENTER |
325032 |
2216 LESTER DRIVE NE |
ALBUQUERQUE |
NM |
87112 |
2019-03-22 |
756 |
E |
0 |
1 |
8F5T11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** This is a repeat deficiency from the survey dated 03/14/18. Based on record review and interview, the facility failed to ensure that pharmacy recommendations were reviewed, responded to, and/or any changes or reasons to decline a change were documented in the medical chart for 8 residents (R #'s 301, 45, 82, 84, 11, 302, 8 and 89) of 10 (R #'s 301, 45, 82, 84, 11, 302, 8, 89, 27 and 19) residents reviewed for unnecessary medications. This deficient practice has the potential to cause harm to residents by: 1. not receiving the proper dose of a medication, 2. not having medications adjusted according to labwork, The findings are: Findings for R #301: [NAME] Record review of R #301's pharmacy consultation report dated (MONTH) (YEAR) indicated that there were three recommendations: 1. Adjust the dose of [MEDICATION NAME] (used for mood as an anticonvulsant, and nerve pain) to 700 milligrams (mg) once daily: for CrCl (Creatinine Clearance)15-29 milliliter/minimum ( to check kidney function) total daily dose range 200 mg to 700 mg given in one daily dose. The Rational for Recommendation is that dosing should be adjusted according to renal (kidney) function. 2. Consider changing [MEDICATION NAME] (is used to treat high blood pressure) to an alternate antihypertensive. The Rational for Recommendation is that Thiazide diuretics are considered less effective when Creatinine clearance drops below 30 ml/min. 3. Consider discontinuing Duloxetine (anti-depressant medication) and starting a new antidepressant. R #301 has [MEDICAL CONDITION] stage 3 and an estimated Creatinine Clearance of 26. Recommendation is for any person who has CrCL less than 30 to switch to something else. The response from the physician was (name of company) declined the recommendation without providing a rationale as to why. B. Record review of R #301's pharmacy consultation report dated (MONTH) (YEAR) indicated that there were three recommendations: 1. R #301 was on [MEDICATION NAME] (a diuretic which helps to not retain fluid) and has not had an electrolyte evaluation (an electrolyte panel help investigate conditions that cause electrolyte imbalances such as dehydration, kidney disease, lung diseases, or heart conditions) in the previous 6 months. Consider doing a Basic Metabolic Panel (BMP, a panel of 8 tests that gives a health practitioner important information about a residents current status) on the next lab day. 2. Attempt a gradual dose reduction (GDR) of [MEDICATION NAME] (an anti-psychotic) PO (by mouth) from 5 mg to 2.5 mg. R #301 has been on the 5mg dose since 11/2017. 3. R #301 has diabetes and needs her A1C (test of glucose in the blood over a period spanning around 3 months) completed. It has not been done in the previous six months. Please consider monitoring A1C on the next lab day. 4. The response from the physician was (name of company) refused the recommendation without providing a rationale as to why. Findings for R #45: C. Record review of R #45's pharmacy consultation report dated (MONTH) (YEAR) indicated that there was one recommendation that was a repeat recommendation from (MONTH) (YEAR). 1. As needed (PRN) [MEDICATION NAME] (antianxiety) did not have a stop date. PRN antipsychotic [MEDICAL CONDITION] drugs are limited to 14 days unless the prescriber documents a specific concern or condition that is being treated, rationale for the extended time period and duration for the PRN order. There was also a recommendation to have a lab done to monitor R #45's TSH ([MEDICAL CONDITION]-stimulating hormone is a pituitary hormone that stimulates the [MEDICAL CONDITION] to produce [MEDICATION NAME] .) Written at the bottom of both consultation reports (name of company) no response multiple attempts. Findings for R #82: D. Record review of R #82's pharmacy consultation report dated (MONTH) (YEAR) indicated that there were two recommendations: 1. R #82 receives [MEDICATION NAME] 20 mg for management of major [MEDICAL CONDITION] since 02/2017. Please consider a GDR unless it is clinically contraindicated at this time. 2. Please consider monitoring BMP on the next lab day due to R #82 receiving Lorsartan (used to treat high blood pressure and heart failure. It is also used to improve the chance of living longer after a [MEDICAL CONDITION]) but does not have a Creatinine/electrolyte evaluation within the past 6 months. Written at the bottom of both consultation reports (name of company) no response multiple attempts. Findings for R #84, R #11 and R #302: E. Record review of the pharmacy consultation report dated (MONTH) (YEAR) indicated the following three recommendations for R #s 84, 11 and 302: 1. R #84 had a PRN (as needed) order for the antipsychotic [MEDICATION NAME] for more than 14 days without a stop date. The recommendations for R #84 is that PRN orders should be limited to 14 days unless the prescriber documents the condition being treated or the rationale for using the drug for an extended time. The response was not checked and at the bottom of the page is written no response from (name of company) multiple attempts. 2. R #302 had a PRN order [MEDICATION NAME] (antianxiety) without a stop date. The recommendations for R #302 is that PRN orders should be limited to 14 days unless the prescriber documents the condition being treated or the rationale for using the drug for an extended time. The response was not checked and at the bottom of the page is written no response from (name of company) multiple attempts. 3. R #11 had a PRN order for [MEDICATION NAME] longer than 14 days without a stop date. The recommendations for R #11 are that PRN orders should be limited to 14 days unless the prescriber documents the condition being treated or the rationale for using the drug for an extended time; and the prescriber should directly examine the resident and assess the residents condition to determine if the PRN mediation is still needed. The response was not checked and at the bottom of the page is written no response from (name of company) multiple attempts. Findings for R #8: F. Record review of R #8's pharmacy consultation report dated (MONTH) (YEAR) indicated that there was one recommendation that was a repeat recommendation from (MONTH) (YEAR). 1. R #8 has a PRN order for [MEDICATION NAME] (antianxiety) with no stop date. The recommendations for R #8 are that PRN orders should be limited to 14 days unless the prescriber documents the condition being treated or there is a rationale for using the drug for an extended time; and the prescriber should directly examine the resident and assess the residents condition to determine if the PRN medication is still needed. Hand written at the bottom of the page indicated: (name of company) multiple attempts. 2. R #8 receives Duloxetine 60 mg QD (every day). [MEDICATION NAME] Clearance of 29 mL/min on 08/28/18 with no recent labs in the medical chart. Consider a GDR of the Duloxetine to 40 mg QD with end goal of discontinuation. If therapy is to continue at current dose it is recommended that the prescriber to assessment of risk vs. benefit that it continues to be a valid therapeutic intervention for this individual. The physician's response was to decline the recommendation stating that (name of company) would do the lab. It was not clear at end of survey whether this lab work was completed. Findings for R #89 [NAME] Record review of the pharmacy consultation report dated (MONTH) 1, (YEAR) to (MONTH) 31st, (YEAR) indicated that there was one recommendation for R #89 that was a repeat recommendation from (MONTH) (YEAR). 1. R #89 received [MEDICATION NAME] (anti-epileptic drug, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of [MEDICAL CONDITION] and some types of pain) and it was written in a (name of company) note that she (R #89) was experiencing hallucinations. The recommendation was to reevaluate the continued use of [MEDICATION NAME]. 2. A recommendation to attempt a GDR of quetiapine (an antipsychotic medication) that R #89 had been on since 01/2018 from 75 mg QD (every day) and 25 mg Q (every) 4 hours as needed, to 50 mg QD (every day) with end goal of discontinuation. For both recommendations, at the bottom of the page is written no response from (name of company) multiple attempts. H. Record review of the pharmacy consultation report dated (MONTH) 1, (YEAR) to (MONTH) 31st, (YEAR) indicated that there was three recommendations for R #89, with one being a repeat recommendation. 1. A repeat recommendation from 07/02/18 and 08/11/18 indicated that there was no stop date for the PRN medication [MEDICATION NAME] (an antipsychotic medication). There is a response that indicated a verbal decline from (name of company) on 10/11/18. 2. There was a recommendation to consider a GDR for [MEDICATION NAME] 200 mg TID (three times per day) to [MEDICATION NAME] 200 mg BID (twice per day). At the bottom in writing it indicated that (name of company) declined. There was no rationale or explanation as to why it was declined. R #89 has remained on this same dose and frequency with no changes, since this recommendation was made. 3. A recommendation to monitor R #89's serum Creatinine because she was on [MEDICATION NAME] on next lab day and every six months thereafter. This was declined, indicating the (name of company) does their own labs. Record review of the labwork in the medical chart did not show that this was completed. For all three of these recommendations, it is unclear if the recommendations were done, were declined after consideration, completed with new orders, or completed with no new orders. I. On 03/21/19 at 11:18 am, during an interview with Licensed Practical Nurse #1, she stated that the pharmacy that is reviewing the medications for the residents residing at the facility should not be reviewing the residents that are apart of the (name of company) residents. Since (name of company) has their own physician's and they use a different pharmacy they should have a pharmacist that reviews the medications for these residents. She also stated that she had not ever seen any pharmacy reviews from the pharmacy that had been prescribing medications to these residents. LPN #1 also stated that when labs are ordered, the (name of company) will usually call the facility and have the facility utilize the lab that they use. Residents don't get sent out to a different lab or go to the (name of company) clinic to have labs drawn. LPN #1 stated that because they usually use their lab for labwork, then all of lab results should be in the electronic medical record or the paper chart. [NAME] On 03/21/19 at 11:28 am, during an interview with with Center Executive Director, she stated that there is a communication problem between the facility and (name of company). They don't always respond to the pharmacy reviews and the Administrator has requested to receive the pharmacy reviews back but they have not or can not produce any to them. K. On 03/21/19 at 2:58 pm, during an interview with Unit Manger #1, she stated that there are constant issues with (name of company). She stated that she is supposed to call the nurse line but stopped doing that and started calling the emergency line because that was the only way to get a response. She also stated that they can't make any changes with any of the medications because it has to come from (name of company) physician's. Unit Manager #1 stated that an example of an issue would be: R #38 was prescribed an antidepressant, (unable to remember the name) when she got the order from (name of company) it was already (MONTH) 2019. The order had been written in (MONTH) 2019. UM #1 called the power of attorney to ask if she had been notified of the medication. The POA stated that she was unclear of why a depression medication was prescribed and did not see any issues that would suggest her mother was depressed. UM #1 agreed and stated that she had not seen any signs of depression either. UM #1 and the POA had been trying to call (name of company) but had not actually spoken to anyone about it. The POA asked that the antidepressant not be given to her mother. L. On 03/22/19 at 7:46 am, during an interview with the Center Nurse Executive (CNE), She stated that she would send a fax to (name of company). Then (name of company) faxes them to the pharmacist and that pharmacist reviews them. The CNE stated that it seems like (name of company) maybe making some changes and doing some labs for their residents but that they (the facility) would not know that because they never send any responses back to the facility. There are times that (name of company) may fax over new orders to the facility based on a recommendation or lab but they don't ever give us that information. The CNE also stated that she is now has the pharmacist phone number and will be dealing directly with her. She stated that this is the first time (03/22/19) she had ever gotten the pharmacy consults back from (name of company). The CNE stated that the facility has no idea what had been acted on, changed, or declined, from (name of company). M. Record review of the facility Healthcare Center Supplemental Monthly Medication Regimen Review, revised 12/12/18, 9.1 Timeframe's for Pharmacy Consultant Recommendation Process, third bullet down Physician/PA (Physician Assistant)/ANP (Adult Nurse Practionier) will return completed MMR (Monthly Medication Review) Consultant Reports within 10 days. N. Record review of a collaboration meeting on 03/21/19 between the facility and (name of company) indicated that the facility was addressing the lack of physician oversight of patients with their program. (Name of company) responded that they had not been able to meet these requirements with the current provider staff at this time but new providers are coming on board and they will be able to comply moving forward. |
2020-09-01 |