| 45 |
LEFA SERAN SNF |
295001 |
1ST AND A ST/ PO BOX 1510 |
HAWTHORNE |
NV |
89415 |
2017-10-12 |
329 |
E |
0 |
1 |
Z18S11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and document review, the facility failed to ensure resident's received timely Gradual Dose Reduction's (GDR's), for 2 of 10 sampled residents (Resident #1, #4) specific rational for continued usage for 1 of 10 sampled residents (Resident #4) and obtain informed consents for [MEDICAL CONDITION] medications for 4 of 10 sampled residents (Resident #4, #8, #9 and #10). Findings include: Resident #8 Resident #8 was admitted on [DATE] and re-admitted on [DATE], with a [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. Resident #8's clinical record documented the resident was continuously administered [MEDICATION NAME] tablet 0.5 mg, and lacked documented evidence of a signed informed consent for the use of [MEDICATION NAME]. On 10/12/17 at 9:40 AM, the Director of Nursing (DON) confirmed there was no signed informed consent for the use of [MEDICATION NAME] in Resident #8's clinical record. The DON verbalized a consent was required prior to the administration of [MEDICATION NAME]. Resident #4 Resident #4 was admitted on [DATE], with [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. Resident #4's Medication Administration Record [REDACTED]. Resident #4's clinical record revealed an informed consent for [MEDICATION NAME] tablet 2.5 mg signed and dated by the resident 05/08/17. On 10/09/17 at 4:31 PM, the Director of Nursing (DON), confirmed Resident #4 signed the informed consent for [MEDICATION NAME] tablet 2.5 MG on 05/08/17. The DON verbalized the resident received [MEDICATION NAME] on 05/05/17, 05/06/17, and 05/07/17 prior to the informed consent having been signed. A physician's orders [REDACTED]. A Psychoactive Medication Review Form dated 07/25/17, for [MEDICATION NAME] 0.5 mg documented the rational to decline an attempt for a gradual dose reduction was,would cont. option for use. (sic) On 10/12/17 at 2:00 PM, the DON explained the rational provided for Resident #4's Psychoactive Medication Review Form dated 07/25/17, for [MEDICATION NAME] 0.5 mg was not sufficient to continue the use of the medication. Resident #1 Resident #1 was admitted on [DATE], with [DIAGNOSES REDACTED]. Resident #1's physician's orders [REDACTED]. Resident #1's clinical record revealed a Psychoactive Medication Review Form, signed by a physician on 03/13/17. The form documented a physician's rationale to decline a gradual dose reduction. Resident #1's second Psychoactive Medication Review Form signed by a physician on 08/28/17, documented a rationale she is doing fine with current dose. On 10/12/17 at 1:45 PM, the Director of Nursing (DON) verbalized two attempts at gradual dose reduction or a physician's rationale for continued usage were required for the first year of an anti-depressant. The DON confirmed Resident #1 did not have a second rationale or gradual dose reduction for [MEDICATION NAME] in the first year at the 15 mg dose as required. The DON reviewed the Psychoactive Medication Review Form signed by a physician on 08/28/17, and verbalized the rationale was very broad. The facility policy titled Drug Reduction, revised 12/15, documented after initiating a psychopharmacological medication, a gradual dose reduction and tapering schedule was to be in two separate quarters separated by at least a month and then annually unless clinically contraindicated. Continued usage required a physician to document the clinical rationale for why the attempted dose reduction would be likely to impair the resident's function or cause psychiatric instability or the resident's target symptoms returned or worsened after the most recent attempt at tapering the dose and the physician documented the clinical rationale. Resident #9 Resident #9 was admitted on [DATE], with [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. The dose was decreased to 75 mg on 11/16/16 and to 50 mg on 04/17/17. Resident #9's clinical record documented the resident was continuously administered [MEDICATION NAME], and lacked documented evidence of a signed informed consent for the use of [MEDICATION NAME]. On 10/12/17 at 9:50 AM, the DON confirmed there was no signed informed consent for the use of [MEDICATION NAME] in Resident #9's clinical record. The DON verbalized a consent was required prior to the administration of [MEDICATION NAME]. Resident #10 Resident #10 was admitted on [DATE], with [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. Resident #10's clinical record documented the resident was continuously administered [MEDICATION NAME], and lacked documented evidence of a signed informed consent for the use of [MEDICATION NAME]. On 10/12/17 at 9:50 AM, the DON confirmed there was no signed informed consent for the use of [MEDICATION NAME] in Resident #10's clinical record. The DON verbalized a consent was required prior to the administration of [MEDICATION NAME]. |
2020-09-01 |