INITIAL COMMENTS
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This report is a result of an on-site inspection conducted for the approval to use a narcotic agent, specifically buprenorphine, in the treatment of narcotic addiction. This inspection was conducted on July 14, 2009 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 compliance with the applicable chapters of 28 PA Code which pertain to the facility. Deficiencies were identified during this inspection and a plan of correction is due on August 8, 2009.
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Plan of Correction
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715.15(b) LICENSURE Medication dosage
(b) The narcotic treatment physician shall determine the proper dosage level for a patient, except as otherwise provided in this section. If the narcotic treatment physician determining the initial dose is not the narcotic treatment physician who conducted the patient examination, the narcotic treatment physician shall consult with the narcotic treatment physician who performed the examination before determining the patient 's initial dose and schedule.
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Observations
Based on a review of patient records, the facility failed to document the consultation between the narcotic treatment physician determining the initial dose and the narcotic treatment physician performing the physical examination, as required, in 3 of 8 records.
The findings include:
Eight records were reviewed on July 14, 2009. Documentation of dose determination was required in all records. In patient records #1, 2 and 6 the narcotic treatment physician who determined the initial dose failed to document the consultation with the certified physician assistant (PA-C) who had completed the physical examination.
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Plan of Correction
A documentation change has been designed and implemented in the electronic medical in which the treating physician is electronically/automatically notified [alerted] of the completion of the medical history and physical exam by the physician's assistant, thus requiring a consultation. The notification remains active until the treating physician documents the consultation in the medical record.
This should eliminate the human error of documenting the consult.
The Medical Director will monitor compliance with the documentation requirement through regularly scheduled weekly "medication rounds" meetings. Noncompliance will recorded, with further corrective action as needed.
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