INITIAL COMMENTS
|
This report is a result of an initial on-site inspection for the approval to use a narcotic agent, specifically methadone, in the treatment of narcotic addiction. This inspection was conducted on November 12, 2008 by staff of the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Habit OPCO - Allentown was found not to be in compliance with the applicable chapters of 4 PA Code and 28 PA Code which pertain to the facility. The following deficiencies were identified during this inspection and a plan of correction is due on December 18, 2008.
|
Plan of Correction
|
715.9(a)(4) LICENSURE Intake
(a) Prior to administration of an agent, a narcotic treatment program shall screen each individual to determine eligibility for admission. The narcotic treatment program shall:
(4) Have a narcotic treatment physician make a face-to-face determination of whether an individual is currently physiologically dependent upon a narcotic drug and has been physiologically dependent for at least 1 year prior to admission for maintenance treatment. The narcotic treatment physician shall document in the patient 's record the basis for the determination of current dependency and evidence of a 1 year history of addiction.
|
Observations
Based on the review patient records, the narcotic treatment program failed to have a narcotic treatment physician make a face-to face determination and document in the patient's record the basis for determining an individual's physiological dependence upon a narcotic drug in 2 of 2 patient records.
The finding include:
Two patient records were reviewed on November 12, 2008. The physician's determination of current physiological dependence was required in two patient records. In patient records #1 and 3 there was no documentation verifying that the narcotic treatment physician made a face-to-face determination that the patients were currently dependent and had been dependent for at least one year on a narcotic drug.
|
Plan of Correction
Program Director reviewed documentation deficiencies with physician on December 11, 2008 and records of patient # 1 and 3 were updated to comply with regulation. Documentation requirements for physical exams were reviewed with the physician by the Program Director on December 11, 2008. Files will be reviewed by the Program Director on a weekly basis for 1 month, then on a monthly basis for 3 months, then quarterly random reviews to ensure proper documentation.
|
715.9(c) LICENSURE Intake
(c) If a patient was previously discharged from treatment at another narcotic treatment program, the admitting narcotic treatment program, with patient consent, shall contact the previous facility for the treatment history.
|
Observations
Based on a review of patient records, one was required, with patient consent, to contact the previous facility for the treatment history in one of two records.
The findings include:
Two patient records were reviewed on November 12, 2008. Documentation of an attempt to contact a patient previous facility was required in one patient record. The facility failed to document that they had attempted to obtain patient #1's consent to contact the previous treatment facility for patient treatment history.
|
Plan of Correction
A release of information was obtained for patient #1 for their previous treatment facility on December, 16, 2008. Contact with the previous treatment facility will be documented in the record by December 17, 2008. All staff has been educated in a staff meeting December 15, 2008 on the necessity to obtain releases for previous treatment providers and document in the record. Counselors will obtain releases of information for prior MMT providers at intake, and document contacts, effective immediately. This will be monitored by review of charts on a weekly basis by the Clinical Director on an ongoing basis. |
715.12(1-5) LICENSURE Informed patient consent
A narcotic treatment program shall obtain an informed, voluntary, written consent before an agent may be administered to the patient for either maintenance or detoxification treatment. The following shall appear on the patient consent form:
(1) That methadone and LAAM are narcotic drugs which can be harmful if taken without medical supervision.
(2) That methadone and LAAM are addictive medications and may, like other drugs used in medical practices, produce adverse results.
(3) That alternative methods of treatment exist.
(4) That the possible risks and complications of treatment have been explained to the patient.
(5) That methadone is transmitted to the unborn child and will cause physical dependence.
|
Observations
Based on the review of patient records, the facility failed to obtain a signed consent to treatment before administering an agent, specifically methadone in one of two patient records.
The findings include:
Two patient records were reviewed on November 12, 2008. Signed consents for treatment were required in two patient records. The facility failed to provide documentation of a signed consent for patient # 1 prior to the administration of methadone. The patient entered methadone treatment and was initially dosed on 11/12/08, there was no documentation of a signed consent in the patient record. The facility was unable to provide said documentation when requested.
|
Plan of Correction
Consent to treatment form for record #2 completed 11-14-08. The nurse manager will ensure that consent is complete prior to dosing for all clients effective immediately. Charts will be reviewed by Clinical Director within 1 week of intake to ensure record is complete. Timeframe immediately and ongoing. |