Nursing Investigation Results -

Pennsylvania Department of Health
GWYNEDD HEALTHCARE AND REHABILITATION CENTER
Patient Care Inspection Results

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GWYNEDD HEALTHCARE AND REHABILITATION CENTER
Inspection Results For:

There are  32 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.
GWYNEDD HEALTHCARE AND REHABILITATION CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on a Medicare/Medicaid Recertification survey, State Licensure and Civil Rights Compliance Survey and an Abbreviated Survey in response to a complaint, completed on February 07, 2019, it was determined that Gwynedd Healthcare and Rehabilitation Center was not in compliance with the following requirements of 42 CFR Part 483, Subpart B, Requirments for Long Term Care Facilities and the 28 PA. Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations, related to the Health portion of the survey process.































 Plan of Correction:


483.21(b)(1) REQUIREMENT Develop/Implement Comprehensive Care Plan:This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.
483.21(b) Comprehensive Care Plans
483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at 483.10(c)(2) and 483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following -
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under 483.24, 483.25 or 483.40; and
(ii) Any services that would otherwise be required under 483.24, 483.25 or 483.40 but are not provided due to the resident's exercise of rights under 483.10, including the right to refuse treatment under 483.10(c)(6).
(iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident's medical record.
(iv)In consultation with the resident and the resident's representative(s)-
(A) The resident's goals for admission and desired outcomes.
(B) The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.
(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.
Observations:

Based on review of clinical records, observations and staff interviews, it was determined that the facility failed to develop and/or implement comprehensive care plans that included specific and individualized interventions to address residents' care needs related to hearing loss, anxiety, dehydration, and being non-compliant with care and medication for four of 35 resident records reviewed (Resident R1, R19, R45, and R163).

Findings include:

Review of Resident R1's clinical record revealed the resident was admitted to the facility on May 31, 2016, with a diagnosis to include major depressive disorder (A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life).

Resident R1 was interviewed with the resident's representative on February 4, 2019, at 11:40 a.m., where it was noted that the resident had hearing difficulty and it was difficult for the resident to understand what was being said. The resident's representative stated that the resident had lost her hearing aides sometime in January 2019.

Review of the facility's investigation regarding the resident's lost hearing aides dated January 7, 2019, revealed the hearing aides were unable to be located and the resident would be scheduled for a audiologist consult. Review of the audiologist consult dated February 6, 2019, revealed the resident needs bilateral hearing aides related to bilateral sensorineural hearing loss (Hearing loss caused by damage to the inner ear or the nerve from the ear to the brain).

Further, review of Resident R1's clinical record revealed no care plan was developed related to communication regarding the resident's hearing loss.

Interview on February 7, 2019, at approximately 11:00 a.m. where she confirmed that Resident R1 did not have a care plan developed related to communication regarding the resident's hearing loss.

Review of Resident R19's clinical record revealed the resident was admitted to the facility on July 28, 2016, with a diagnosis to include Alzheimer's disease (A progressive disease that destroys memory and other important mental functions).

Observation on February 5, 2019, at 9:25 a.m. revealed Resident R19 refused her physician ordered multivitamin tablet. Review of Resident R19's clinical record revealed the resident had refused the multivitamin on December 8, 9, 13, 17, 22, and 27, 2018. Further, review of Resident R19's clinical record revealed no care plan related to the resident's medication refusals.

Interview on February 6, 2019, at 8:40 a.m. with the DON, where she confirmed the resident did not have a care plan developed related to the resident's refusals of medications.

Review of Resident R45's January 2019 physician orders revealed diagnoses of delirium (can be characterized by confusion, anxiety and incoherent speech), aphasia (impaired speech), dysphagia (difficulties swallowing) and Dementia. Review of Resident R45's care plan revealed the resident required assistance from nursing staff for incontinence care, dressing, personal hygiene and feeding. Review of Resident R45's nursing notes revealed on 2/17/18, 4/16/18, 11/3/18, 11/26/18, 11/28/18, 12/10/18, 12/11/18, 12/13/18, 1/3/19, 1/12/19, 1/20/19, and 1/21/19 indicated times the resident was either combative, non-compliant with personal care and/or refusing medication.

Further review of Resident 45's care plans did not reflect goals or interventions necessary to address the resident's combative behaviors and being noncompliant. On February 6, 2019 at approximately 1:30 p.m. this was confirmed with the Nursing Home Administrator and the Director of Nursing that the facility failed to develop a comprehensive care plan to meet Resident R45 medical, nursing, and mental needs.

Review of Resident R163's care plan revealed an admission date on January 14, 2019 with diagnoses that included Anxiety, Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH makes it hard for your body to release water which causes levels of sodium to fall as a result of water retention), hyponatremia (is low sodium) and used a Foley catheter (a tube that goes into the bladder to drain urine).

Review of Resident R163's physician orders revealed the resident had a daily fluid restriction of 1000 milliliters related to the hyponatremia. Review of Resident R163's care plan for the potential risk for fluid volume deficit dated, January 22, 2019, revealed nursing was to monitor for the signs and symptoms of dehydration by assessing the urine for decreased output. Review of Resident R163's care plan for the Foley catheter dated, January 22, 2019 revealed assessing for signs and symptoms of infection by maintaining adequate output of urine. During the entire full health survey there was no documentation that was available for review revealing the facility was monitoring the resident's urine output. On February 7, 2019 at, approximately 1:00 p.m. the Director of Nursing confirmed the facility failed to implement the care plans by not monitoring or assessing Resident R163's urine output for signs and symptoms of infection and/or dehydration.

Further review of Resident R163's care plans revealed a psychotropic drug care plan due to the diagnoses of anxiety and depression dated, January 22, 2019. The care plan also included utilizing a non-pharmacological approach to reduce the resident's anxiety by engaging in activities, offering a snack or nursing making frequent room visits. The care plan also indicated the resident would receive Ativan (an anti-anxiety medication) for anxiety, in which the smallest, most effective dose would be administered and to monitor and report the effectiveness of the Ativan when it was administered.

Review of the facility's documentation titled "Controlled Medication Record" for Resident R163, revealed Ativan was given to the resident from January 16, 2019 to January 29, 2019 and from February 2, 2019 to February 6, 2019. Review of Resident R163's clinical records revealed the facility did not attempt utilizing a non-pharmacological approach prior to receiving the Ativan, nor was the medication monitored or documented for the effectiveness when it was administered. The facility failed to implement the care plan's interventions related to Resident R163's anxiety.

The facility failed to develop and/or implement residents' care plans that included specific and individualized interventions to address care needs related to hearing loss, anxiety, Foley catheter care and being non-compliant to nursing care and medication administration.

28 Pa. Code 211.11(d) Resident care plans.




 Plan of Correction - To be completed: 03/12/2019

1. Facility reviewed and updated accordingly the care plans for resident's R1, R19, R45, and R163.
2. Care plans for Residents with hearing loss will be implemented and include specific individualized interventions to address care needs. Care Plans for Residents with medication refusals and Residents who are non- compliant/combative with care in the last 30 days will be updated and reviewed. Care Plans for residents with anxiety and Foley catheters in the last 30 days will be reviewed and implemented to include specific individualized interventions to address care needs.
3. Licensed Nurses will be re-educated by the Director of Nursing/Designee to ensure that nurses are implementing resident care plans that include specific and individualized interventions to address care needs related to hearing loss, anxiety, Foley catheter care and being non- compliant to nursing care and med administration.
4. Random Audits will be completed weekly x4 then monthly x3 by the Director of Nursing/Designee to ensure that care plans are implemented and include specific individualized interventions to address care needs for residents with hearing loss, anxiety, Foley catheter care and being non -compliant to nursing care and medication administration.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.

483.80(a)(1)(2)(4)(e)(f) REQUIREMENT Infection Prevention & Control:This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.
483.80 Infection Control
The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.

483.80(a) Infection prevention and control program.
The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements:

483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to 483.70(e) and following accepted national standards;

483.80(a)(2) Written standards, policies, and procedures for the program, which must include, but are not limited to:
(i) A system of surveillance designed to identify possible communicable diseases or
infections before they can spread to other persons in the facility;
(ii) When and to whom possible incidents of communicable disease or infections should be reported;
(iii) Standard and transmission-based precautions to be followed to prevent spread of infections;
(iv)When and how isolation should be used for a resident; including but not limited to:
(A) The type and duration of the isolation, depending upon the infectious agent or organism involved, and
(B) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances.
(v) The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease; and
(vi)The hand hygiene procedures to be followed by staff involved in direct resident contact.

483.80(a)(4) A system for recording incidents identified under the facility's IPCP and the corrective actions taken by the facility.

483.80(e) Linens.
Personnel must handle, store, process, and transport linens so as to prevent the spread of infection.

483.80(f) Annual review.
The facility will conduct an annual review of its IPCP and update their program, as necessary.
Observations:

Based on observations, review of facility policies, and staff interviews, it was determined that the facility failed to ensure proper handwashing during medication administration and wound care treatment and failed to develop an adequate hand washing policy.

Findings include:

Review of the Centers for Disease Control and Prevention (CDC) recommendations for handwashing, dated reviewed September 4, 2015, revealed the following instructions: first wet hands with running water, then lather hands by rubbing together with soap, scrub for at least twenty seconds, before rinsing under running water then drying with a clean towel.

Review of facility policy "Hand Hygiene Policy," no date revealed the purpose of the policy is that hand washing or hand sanitizer is one of the best ways to stop the spread of infection. The policy had a statement that Hands should be washed for no less that 20 seconds. Further, review of the facility's policy revealed no further instruction on how staff should perform handwashing to include first wet hands with running water, then lather hands by rubbing together with soap, scrub for at least twenty seconds, before rinsing under running water then drying with a clean towel as outlined by the CDC.

Observation on February 5, 2019, of Employee E4, RN, at 8:45 a.m. during medication administration revealed she lathered her hands under running water for less than 20 seconds and turned off the faucet with her bare hands.

Interview on February 5, 2019 at 11:30 a.m. with Employee E4, RN, where she confirmed she lathered her hands under running water for less than 20 seconds and turned off the faucet with her bare hands.

Observation on February 5, 2019, of Employee E5, LPN, at 9:30 a.m. during medication administration revealed she lathered her hands under running water for less than 20 seconds.

Interview on February 5, 2019 at 11:35 a.m. with Employee E5, LPN, where she confirmed she lathered her hands under running water for less than 20 seconds.

Observation on February 5, 2019 at 11:00 a.m. with Employee E6 during wound care for Resident R65 revealed Employee E6, LPN, lathering her hands under running water for less than 20 seconds.

Interview on February 5, 2019 at 11:30 a.m. with Employee E6 confirmed she lathered her hands under running water for less than 20 seconds.

The facility failed to ensure proper handwashing during medication administration and wound care treatment and failed to develop an adequate hand washing policy.


28 Pa. Code 201.14(a) Responsibility of licensee

28 Pa. Code 205.26(a)(d) Laundry

Pa. Code 211.12(d)(1)(5) Nursing services



















 Plan of Correction - To be completed: 03/12/2019

1. Employees: E4, E5, and E6 received re-education for deficient practice.
2. Facility will complete infection prevention and control competencies with licensed nurses to ensure that they are using proper hand washing techniques during medication administration and wound treatments. The facility hand washing policy has been reviewed and updated as needed.
3. Licensed Nurses will be re-educated by the Director of Nursing/Designee to ensure that they are utilizing proper hand washing techniques during medication administration and wound treatments. Staff will be re-educated on the updated hand washing policy by the Director of Nursing/Designee.
4. Random audits will be completed weekly x4 then monthly x3 by the Director of Nursing /Designee to ensure that licensed nurses are utilizing proper handwashing techniques during medication administration and wound treatments.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.



483.45(a)(b)(1)-(3) REQUIREMENT Pharmacy Srvcs/Procedures/Pharmacist/Records:This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.
483.45 Pharmacy Services
The facility must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in 483.70(g). The facility may permit unlicensed personnel to administer drugs if State law permits, but only under the general supervision of a licensed nurse.

483.45(a) Procedures. A facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident.

483.45(b) Service Consultation. The facility must employ or obtain the services of a licensed pharmacist who-

483.45(b)(1) Provides consultation on all aspects of the provision of pharmacy services in the facility.

483.45(b)(2) Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; and

483.45(b)(3) Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled.
Observations:

Based on review of clinical records and resident and staff interview it was determined that the facility failed to implement procedures to ensure availability of prescribed medications for one of 29 Resident reviewed (Resident 66).

Findings include:

Review of the facility emergency drug box (medications that are available to staff for instances such as new medication orders) revealed ferrous sulfate (iron supplement) was not a medication that was available to nursing staff if a medication had not been available in the facilty.

Review of Resident R324's clinical record revealed the resident was admitted to the facility on January 19, 2019, with a diagnosis to include anemia (condition in which the blood doesn't have enough healthy red blood cells) and chronic kidney disease (Longstanding disease of the kidneys leading to renal failure). Review of Resident R324's clinical record revealed an order for a physician order dated January 29, 2019, for Ferrous Sulfate 325 mg's daily.

Observation on February 5, 2019, at 9:10 a.m. of Employee E3, RN, administering medications to Resident R324, revealed the Ferrous Sulfate 325 mg's was not available in the facility. Employee E3, RN, initialed the ferrous sulfate on the resident's medication administration record (MAR) and circled her initials. Further, review of the resident's MAR revealed the following regarding the ferrous sulfate: the medication was documented as administered on January 30 and 31, 2019; circled on February 1, 2019; and documented as administered on February 2, 3, and 4, 2019.

Review of the facility's internal investigation (no date) related to Resident R324's regarding the ferrous sulfate revealed the medication had not been delivered to the facility via the contracted pharmacy and three nurses had "borrowed" ferrous sulfate from other resident's to use for Resident R324.

Interview on February 6, 2019, at 11:00 a.m. with the administrator, where she confirmed the medication had not been delivered to the facility via the contracted pharmacy and the facility's investigation revealed that three nurses had "borrowed" ferrous sulfate from other resident's to use for Resident R324.

The facility failed to implement procedures to ensure availability of prescribed medications.


28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.












 Plan of Correction - To be completed: 03/12/2019

1. The facility received the ferrous sulfate from the contracted pharmacy for Resident R324.
2. The facility has implemented procedures to ensure that ferrous sulfate is available for residents. Ferrous sulfate is now a stock medication.
3. Licensed nurses will be re-educated on ensuring that if meds are not received timely from the contracted pharmacy to notify DON/NHA.
4. Random audits will be completed weekly x4 then monthly x3 by the Director of Nursing/Designee to ensure that licensed nurses are following the correct procedure regarding contacting the pharmacy when prescribed medications are not available.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.

483.21(b)(3)(i) REQUIREMENT Services Provided Meet Professional Standards:This is a less serious (but not lowest level) deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status.
483.21(b)(3) Comprehensive Care Plans
The services provided or arranged by the facility, as outlined by the comprehensive care plan, must-
(i) Meet professional standards of quality.
Observations:

Based on observation, clinical record review, review of facility documentation, and staff interview, it was determined that the facility failed to adhere to acceptable standards of nursing practice related to medication administration for one of six residents observed during medication administration. (Residents R324).

Findings include:

The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11(b), General Functions of the Registered Nurse (RN), and 21.14(a), Administration of Drugs, indicated that the RN is fully responsible for all actions as a licensed nurse and is accountable to patients for the quality of care delivered, and administers medication ordered for the patient in the dosage and manner prescribed. The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.145(a)(b), Functions of the Licensed Practical Nurse (LPN), indicated that the LPN functions as a member of the health-care team by exercising sound nursing judgement based on preparation, knowledge, experience in nursing and competency, and administers medication ordered for the patient.

Review of Resident R324's clinical record revealed the resident was admitted to the facility on January 19, 2019, with a diagnosis to include anemia (condition in which the blood doesn't have enough healthy red blood cells) and chronic kidney disease (Longstanding disease of the kidneys leading to renal failure). Review of Resident R324's clinical record revealed a physician order dated January 29, 2019, for Ferrous Sulfate (iron supplement) 325 mg's daily.

Observation on February 5, 2019, at 9:10 a.m. of Employee E3, RN, administering medications to Resident R324, revealed the Ferrous Sulfate 325 mg's was not available in the facility. Employee E3, RN, initialed the ferrous sulfate on the resident's medication administration record (MAR) and circled her initials. Further, review of the resident's MAR revealed the following regarding the ferrous sulfate: the medication was documented as administered on January 30 and 31, 2019; circled on February 1, 2019; and documented as administered on February 2, 3, and 4, 2019.

Review of the facility's internal investigation (no date) related to Resident R324's ferrous sulfate revealed the medication had not been delivered to the facility via the contracted pharmacy and three licensed nurses had "borrowed" (Facility staff may encounter situations in which a medication is not available in the resident's supply or the facility's emergency medication supply and then decide to "borrow" medications from another resident's supply. This practice of borrowing medications from other residents' supplies is not consistent with professional standards and contributes to medication errors) ferrous sulfate from other resident's to use for Resident R324.

Interview on February 6, 2019, at 11:00 a.m. with the administrator, where she confirmed the medication had not been delivered to the facility via the contracted pharmacy and the facility's investigation revealed that three licensed nurses had "borrowed" ferrous sulfate from other resident's to use for Resident R324.

The facility failed to adhere to acceptable standards of nursing practice related to medication administration.

28 Pa. Code: 201.18(b)(1) Management.

28 Pa. Code: 211.12(d)(3)(5) Nursing services.






 Plan of Correction - To be completed: 03/12/2019

1. The ferrous sulfate that was utilized for resident R324 was returned to the other resident at facilities expense. Employees involved received re-education.
2. Medication administration competencies will be completed with licensed nurses to ensure that they are adhering to acceptable standards of nursing practice as it relates to medication administration ensuring that medications are not to be borrowed.
3. Licensed Nurses will be re-educated by the Director of Nursing/Designee to ensure that nurses are adhering to acceptable standards of nursing practices related to medication administration and borrowing medications.
4. Random audits will be completed weekly x4 then monthly x3 by the Director of Nursing/Designee to ensure that nurses are not borrowing medications.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.

483.45(c)(3)(e)(1)-(5) REQUIREMENT Free from Unnec Psychotropic Meds/PRN Use:This is a less serious (but not lowest level) deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status.
483.45(e) Psychotropic Drugs.
483.45(c)(3) A psychotropic drug is any drug that affects brain activities associated with mental processes and behavior. These drugs include, but are not limited to, drugs in the following categories:
(i) Anti-psychotic;
(ii) Anti-depressant;
(iii) Anti-anxiety; and
(iv) Hypnotic

Based on a comprehensive assessment of a resident, the facility must ensure that---

483.45(e)(1) Residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record;

483.45(e)(2) Residents who use psychotropic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs;

483.45(e)(3) Residents do not receive psychotropic drugs pursuant to a PRN order unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record; and

483.45(e)(4) PRN orders for psychotropic drugs are limited to 14 days. Except as provided in 483.45(e)(5), if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order.

483.45(e)(5) PRN orders for anti-psychotic drugs are limited to 14 days and cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication.
Observations:


Based on review of clinical records and an interview with staff it was determined that the facility failed to first utilize a non-pharmacological approach for a behavioral intervention related to anxiety and failed to manage and monitor the administration of a psychotropic drug medication for one of 35 resident records reviewed, (Resident R163).

Finding includes:

Resident R163 was cognitively intact and admitted to the facility on January 14, 2019 with diagnoses of Major Depression Disorder and Anxiety.

Review of Resident R163's care plan for psychotropic drug care due to the diagnoses of anxiety and depression dated, January 22, 2019 revealed utilizing a non-pharmacological approach to reduce the resident's anxiety by engaging in activities, offering a snack or nursing making frequent room visits. The care plan also indicated the resident would receive Ativan (an anti-anxiety medication) for anxiety, in which the smallest, most effective dose would be administered and to monitor and report the effectiveness of the Ativan when it was administered.

Review of the facility's documentation titled "Behavior Monitoring Flow Record" revealed Resident R163 was being monitored every shift for signs and symptoms of depression and/or anxiety for the months of January and February 2019. Review of these records indicated the resident did not experience any episodes of depression and/or anxiety. Further review of the facility's documentation titled "Controlled Medication Record" revealed Resident R163 had an order for Ativan (an anti-anxiety medication) 0.5 milligrams, to be given twice a day as needed for anxiety. The documentation revealed the Ativan was given from January 16, 2019 to January 29, 2019 and from February 2, 2019 to February 6, 2019 when nursing notes did not indicate the resident experiencing anxiety during those dates. Further review of Resident R163 clinical chart did not reveal any non-pharmacological approach was attempted prior to the resident receiving the Ativan medication nor was the medication managed and monitored for effectiveness.

The facility failed to use a non-pharmacological approach for a behavioral intervention related to anxiety and failed to manage and monitor the use of a psychotropic drug medication when administered.

28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.


 Plan of Correction - To be completed: 03/12/2019

1. Licensed Nurses will utilize a non- pharmacological approach with Resident R163 related to their anxiety in conjunction with utilizing PRN psychotropic medications when necessary. Facility is monitoring that there is documentation supporting the need of PRN psychotropic medications for Resident R163 in conjunction to resident receiving the prescribed PRN psychotropic medication as appropriate.
2. Residents who are prescribed PRN psychotropic medications will be reviewed to ensure that non- pharmacological approaches for behavioral interventions are utilized in conjunction with using prescribed PRN psychotropic medications when necessary. Facility will ensure that supporting documentation is completed in conjunction with administering prescribed PRN psychotropic medication when needed.
3. Licensed Nurses will be re-educated by the Director of Nursing/Designee to ensure that non- pharmacological interventions are completed in conjunction with administration of prescribed PRN psychotropic medications and that documentation is completed in conjunction with administering the PRN psychotropic medication as necessary.
4. Random audits will be completed weekly x4 then monthly x3 by the Director of Nursing/Designee to ensure that licensed nurses are utilizing non- pharmacological approaches and interventions in conjunction with administration of PRN psychotropic medications and that if PRN psychotropic medications are needed there is supporting documentation regarding resident's behavior as necessary.
5. Audits will be discussed and reviewed by the facility QAPI committee meeting x3 to ensure compliance.


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