cms_SD: 4

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
4	PRAIRIE HEIGHTS HEALTHCARE	435004	400 8TH AVENUE NW	ABERDEEN	SD	57401	2017-05-17	281	D	0	1	V34811	NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview, and policy review, the provider failed to ensure one of four sampled residents (4) who was an insulin dependent diabetic received her medications as ordered by the physician. Findings include: 1. Review of resident 4's medical record revealed: She had been admitted on [DATE]. Her [DIAGNOSES REDACTED]. Review of resident 4's physician's orders [REDACTED]. [MEDICATION NAME] 3 units (u) every morning (q. a.m.). Humalog insulin: -7 units before breakfast. -4 units before lunch. -2 units before supper. In addition she received additional Humalog insulin on a sliding scale based on a her blood sugars: -201-250: 1 unit. -251-300: 2 units. -301-350: 3 units. -351 or greater: 4 units. The physician was to be notified if her blood sugars were lower than 60 or higher than 450. Review of resident 4's physician's orders [REDACTED]. Review of resident 4's medical record revealed a 5/15/17 fax had been sent to her physician stating Please note that pt (patient) scheduled Humalog was missed over the weekend. Attached to that fax was a copy of her blood sugars. Interview on 5/16/17 at 10:00 a.m. with registered nurse/unit manager A regarding resident 4 revealed: On 4/11/17 the resident's Humalog insulin for the noon meal had been changed from 3 to 4 units. The nurse had yellowed out on the treatment record/medication record the 3 units that meant it had been discontinued. On the next frame of the medication record she wrote the medication change increasing the noon dosage to 4 units. She also yellowed out from 5/11/17 noon dose through 5/31/17, 5/11/17 through 5/31/17 for the supper dose, and 5/12/17 through 5/31/17 for the breakfast doses. -When a medication had been yellowed out that meant that order had been discontinued. She never re-wrote those orders for breakfast or supper, so none of those doses were given. The resident had missed her insulin for seven meals. The error was found on 5/15/17 and immediately reported. The nurse who had made the medication order change had not completed the process correctly. Review of resident 4's blood sugar records from 5/7/17 through 5/15/17 revealed her blood sugars: Had been checked four times per day. Her blood sugars were: -Never lower than 60, nor higher than 400. -Between 201 to 250: seven times. -251 to 300: four times. -301 to 350: four times. -350 or greater: four times. On 5/12/17 her blood sugars ranged from 91 to 198. On 5/13/17 her blood sugars ranged from 197 to 386. On 5/14/17 her blood sugars ranged from 198 to 418. On 5/15/17 her a.m. blood sugar was 145, and her noon time blood sugar was 225. Review of the provider's 8/11/06 professional standard and policy for Orders Management: Medication and Treatment Orders revealed it did not address how to change an order on the medication/treatment record. Interview on 5/17/17 at 11:00 a.m. with the director of nursing regarding resident 4 revealed: When the above medication change occurred the nurse should not have yellowed out all of the Humalog doses without rewriting them along with the new dosage for the noon meal. -She should have put a bracket ( ) around the change and left the other medications without altering them with the yellow highlighter. An error had been made, and the resident missed her scheduled medications.	2020-09-01