|§483.45(c) Drug Regimen Review. |
§483.45(c)(1) The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.
§483.45(c)(2) This review must include a review of the resident's medical chart.
§483.45(c)(4) The pharmacist must report any irregularities to the attending physician and the facility's medical director and director of nursing, and these reports must be acted upon.
(i) Irregularities include, but are not limited to, any drug that meets the criteria set forth in paragraph (d) of this section for an unnecessary drug.
(ii) Any irregularities noted by the pharmacist during this review must be documented on a separate, written report that is sent to the attending physician and the facility's medical director and director of nursing and lists, at a minimum, the resident's name, the relevant drug, and the irregularity the pharmacist identified.
(iii) The attending physician must document in the resident's medical record that the identified irregularity has been reviewed and what, if any, action has been taken to address it. If there is to be no change in the medication, the attending physician should document his or her rationale in the resident's medical record.
§483.45(c)(5) The facility must develop and maintain policies and procedures for the monthly drug regimen review that include, but are not limited to, time frames for the different steps in the process and steps the pharmacist must take when he or she identifies an irregularity that requires urgent action to protect the resident.
Based on clinical record review and staff interview it was determined that the pharmacist failed to identify drug irregularities in the drug regimen of one of 10 residents reviewed (Resident 69).
A review of the clinical record revealed that Resident 69 was admitted to the facility on January 22, 2016, with diagnoses to include anxiety, depression and pain.
The resident had a current physician order, initially dated December 9, 2016, for Norco tablet (a combination narcotic and non-narcotic pain medication) 5-325 mg, take 1 tablet every 4 hours as needed for pain.
A review of the resident's monthly medication administration records dated June 2018 through December 2018, revealed that Resident 69 did not request or receive the Norco, during that six month time period.
A review of the drug regimen reviews conducted by the pharmacist from June 2018 through December 2018, revealed that the pharmacist failed to identify Resident 69's non-use of the pain medication during this time period and recommend that the physician evaluate Resident 69's continued need for the prescribed medication.
During an interview March 14, 2019, at approximately 1:00 PM the Director of Nursing confirmed confirmed that the pharmacist had not identified Resident 69's non-use of the pain medication, Norco.
28 Pa. Code 211.9(a)(1) Pharmacy services
Previously cited 11/2/17
28 Pa. Code 211.9(k) Pharmacy services
Previously cited 1/12/19, 11/2/17
| ||Plan of Correction - To be completed: 04/09/2019|
1. Resident 69 med Narco was discontinued per MD order and disposed of accordingly.
2. Facility will do sweep of current narcotic orders and dispose of properly if not used within 60 days.
3. DON/ADON will educate Pharmacy Consultant on addressing non-use of PRN narcotic medication.
4. DON will audit pharmacy recs weekly to ensure that PRN narcotic non-usage is being monitored.
5. Audits will be submitted to QAPI for review.