This report is a result of an on-site inspection conducted for the approval to use a narcotic agent, specifically Suboxone, in the residential detoxification from opioid dependence. This inspection was conducted on June 5 through June 6, 2012 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Marworth, was found not to be in compliance with the applicable chapters of 28 PA Code which pertain to the facility. The following deficiencies were identified during this inspection.
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Plan of Correction
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Observations
Based on a review of patient records, the narcotic treatment program failed to document the consultation between the narcotic treatment physician determining the initial dose and the narcotic treatment medical staff performing the physical examination in three of four patient records.
The findings include:
Seven patient records were reviewed on June 6, 2012. Four patient records were required to document a consult between the narcotic treatment physician determining the initial dose and the narcotic treatment physician performing the physical examination. The facility failed to document a consult between physicians in patient records # 1, 2, and 3.
Record #1 - the patient was admitted on 5-21-2012. According to the documentation in patient record # 1, a medical resident completed the physical examination with assistance from the medical director on May 22, 2012. The narcotic treatment physician who determined the initial dose documented that the physical examination had been completed and discussed on May 21, 2012, however, the physical examination was not completed at the time that the physician's note was written. The physical examination in this case took place after the documentation by the physician that specified this examination had taken place and following the establishment of the initial medication dose.
Record #2 - The patient was admitted on 6-4-2012. The Physician Assistant (PA) completed the physical examination of patient # 2 on June 5, 2012. The narcotic treatment physician who determined the initial dose on June 4, 2012 documented that the physical examination had been completed and discussed on June 4, 2012, however, the physical exam was not completed at the time the note was written. The physical examination in this case took place after the documentation by the physician that specified this examination had taken place and following the establishment of the initial medication dose.
Record #4 - Patient was admitted on May 30, 2012. The Physician Assistant (PA) completed the physical examination on May 31, 2012. The narcotic treatment physician who determined the initial dose on May 31, 2012, failed to document the consultation with the Physician Assistant who completed the physical examination.
The findings were discussed with the medical director and not disputed.
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Plan of Correction
A complete medical history and physical examination will be completed and documented in the electronic medical record (EMR) before the narcotic orders Suboxone. If the narcotic physician is not the provider doing the physical examination, the narcotic physician will review the examination and discuss the findings with the provider who did the physical. Documentation in the EMR will reflect this transaction. THe narcotic physician will still need to meet face-to-face with the patient.The medical director will be responsible for the education, supervision, and monitoring of this process. |