Nursing Investigation Results -

Pennsylvania Department of Health
ARISTACARE AT PARK AVENUE
Patient Care Inspection Results

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ARISTACARE AT PARK AVENUE
Inspection Results For:

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ARISTACARE AT PARK AVENUE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an Abbreviated Survey in response to a complaint completed on February 5, 2020, it was determined that Aristacare at Park Avenue was not in compliance with the following Requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care Facilities and the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.





















 Plan of Correction:


483.25 REQUIREMENT Quality of Care: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.
483.25 Quality of care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.
Observations:

Based on clinical record review and staff interviews, it was determined that the facility failed to ensure that physician's orders were followed for administration of an as needed medication to treat high blood pressure for one of eight residents reviewed (Resident R1).

Findings include:

Resident R1's clinical record revealed an admission date of 1/7/2020, with diagnoses that included multiple fractures to the pelvis, ribs, and lumbosacral spine, high blood pressure, and diabetes.

Physician orders for Resident R1 dated 1/9/2020, included Hydralazine HCL (medication used to treat high blood pressure) 25 milligrams (mg) every six hours as needed for systolic blood pressure above 150.

Resident R1's blood pressure records revealed the following systolic blood pressure readings for January 2020:

177 on 1/9
154, 159, and 154 on 1/10
167 on 1/11
168 and 167 on 1/12
185 on 1/13
187 on 1/14
168 on 1/17
166 and 154 on 1/18
151 on 1/21

Resident R1's January 2020 Medication Administration Record, revealed that the Hydralazine HCL was not administered as physician ordered for any of the above 13 occurrences with the systolic blood pressure over 150.

During an interview on 2/5/2020, at 3:15 p.m. the Nursing Home Administration and Director of Nursing confirmed that the physician order to administer Hydralazine HCL 25 mg every six hours as needed for systolic blood pressure above 150 was not followed.

438.25 Previously cited 8/30/2019

28 PA Code 211.12(d)(5) Nursing services
Previously cited 8/30/2019




 Plan of Correction - To be completed: 03/13/2020

Resident R1 was discharged from facility on 1/30/2020.
Director of Nursing/designee did a house audit to ensure PRN Physician's orders have been followed for administration to treat high blood pressure.
The Director of Nursing/designee will re-educate licensed staff on PRN medication administration to treat high blood pressure.
The Director of Nursing /designee will audit new physician orders weekly during clinical rounds to ensure physician orders of a PRN medication that treats high blood pressure are followed. Audits will be conducted 5 days a week X4 weeks, 3 days a week X2 months. Then monthly for 3 months to ensure compliance related to following physician orders.
The Quality Assurance Process Improvement committee will review the corrective action and the effectiveness of the plan of correction and all audits.

The Quality Assurance Process Improvement committee will make recommendations to the plan and audit structure to maintain compliance and prevent re-occurrence.


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