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 methadone, in the treatment of narcotic addiction. This inspection was conducted on June 3, 2010 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Pa Care Llc, D/b/a Miners Medical 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 July 3, 2010. .
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Plan of Correction
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715.9(a)(2) 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:
(2) Verify the individual 's identity, including name, address, date of birth, emergency contact and other identifying data.
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Observations
Based on the review of patient records, the facility failed to verify the identity of the patient prior to the administration of an agent in three of four patient records.
The findings include:
Four patient records were reviewed on June 3, 2010 for documentation that verified patient identity information. Patient records # 1, 2 and 4 did not contain any documentation that provided verification of the patient's identity.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |
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.
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Observations
Based on a review of 4 patient records on June 4, 2010, 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 4 of 4 patient records.
Findings:
Four patient records were reviewed on June 4, 2010. There was no documentation verifying that the narcotic treatment physician made a face-to-face determination of the patient's physiological dependence upon a narcotic drug. The patient records for patients # 1, 2, 3 and 4 contained a form for the physician's determination of current dependence and a one year history of addiction. On the form, the physician wrote "refer to to H & P (history and physical)". A review of the history and physical failed to contain supporting documentation that would be used as consideration for the determination of current dependency and a one year history of addiction.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |
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.
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Observations
Based on the review of patient records, the facility failed to contact the previous facility for the patient's treatment history in two of four patient records.
The findings include:
Four patient records were reviewed June 3, 2010. Four patient records required contacting the prior treatment facility for the treatment history. Patient records # 1 and 2 did not contain documentation of any attempt to obtain the patient's prior treatment history from previously attended treatment facilities.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |
715.17(c)(1)(i-vi)) LICENSURE Medication control
(c) A narcotic treatment program shall develop and implement written policies and procedures regarding the medications used by patients which shall include, at a minimum:
(1) Administration of medication.
(i) A narcotic treatment physician shall determine the patient 's initial and subsequent dose and schedule. The physician shall communicate the initial and subsequent dose and schedule to the person responsible for the administration of medication. Each medication order and dosage change shall be written and signed by the narcotic treatment physician.
(ii) An agent shall be administered or dispensed only by a practitioner licensed under the appropriate Federal and State laws to dispense agents to patients.
(iii) Only authorized staff and patients who are receiving medication shall be permitted in the dispensing area.
(iv) There shall be only one patient permitted at a dispensing station at any given time.
(v) Each patient shall be observed when ingesting the agent.
(vi) Administering and dispensing shall be conducted in a manner that protects the patient from disruption or annoyance from other individuals.
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Observations
Based on the review of patient records and a staff interview, the facility failed to restrict the determination of a patient's dose to the physician in 4 of 4 patient records.
The findings include:
Four patient records were reviewed on June 3, 2010; all four patient records were reviewed for medication orders. Patient records # 1, 2, 3 and 4 contained dosing orders that ordered changes in medication that included standing orders that took place without ongoing physician review. Additionally, the physician orders stipulated nursing staff could make determinations to change the dose of a patient.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |
715.20(4) LICENSURE Patient transfers
A narcotic treatment program shall develop written transfer policies and procedures which shall require that the narcotic treatment program transfer a patient to another narcotic treatment program for continued maintenance, detoxification or another treatment activity within 7 days of the request of the patient.
(4) The receiving narcotic treatment program shall document in writing that it notified the transferring narcotic treatment program of the admission of the patient and the date of the initial dose given to the patient by the receiving narcotic treatment program.
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Observations
Based on the review of patient records, the facility failed to document that it notified the referring facility of the admission and initial dosing of the patient in 2 of 4 patient records.
The findings include:
Four patient records were reviewed June 3, 2010. Four patient records were reviewed for documentation of notification to the referring facility of the admission and the initial dosing of the referred patient. Patient records # 3 and 4 were referred by narcotic treatment programs but there was no documentation of the facility's notification to the referring facility of the admission and initial dosing of the patients.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |
715.21(1)(i-iv) LICENSURE Patient termination
A narcotic treatment program shall develop and implement policies and procedures regarding involuntary terminations. Involuntary terminations shall be initiated only when all other efforts to retain the patient in the program have failed.
(1) A narcotic treatment program may involuntarily terminate a patient from the narcotic treatment program if it deems that the termination would be in the best interests of the health or safety of the patient and others, or the program finds any of the following conditions to exist:
(i) The patient has committed or threatened to commit acts of physical violence in or around the narcotic treatment program premises.
(ii) The patient possessed a controlled substance without a prescription or sold or distributed a controlled substance, in or around the narcotic treatment program premises.
(iii) The patient has been absent from the narcotic treatment program for 3 consecutive days or longer without cause.
(iv) The patient has failed to follow treatment plan objectives.
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Observations
Based on the review of patient records, the facility failed to restrict the reasons for involuntary termination to those reasons allowed by regulation in four of four patient records.
The findings include:
Four patient records were reviewed June 3, 2010. Documentation in all patient records included a loitering policy form that required patient signature. In the content of this form was the statement that a patient could be discharged for loitering. The inclusion of this policy exceeded the regulations as the facility failed to limit the reasons for discharge to those reasons identified in the regulations.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |
715.23(b)(15) LICENSURE Patient records
(b) Each patient file shall include the following information:
(15) Psychosocial evaluations of the patient.
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Observations
Based on the review of patient records and staff interviews, the facility failed to document psychosocial evaluations in four of four patient records.
The findings include:
Four patient records were reviewed on June 4, 2010. Psychosocial evaluations were required in all of patient records reviewed. The narcotic treatment program did not include evaluations in all the required areas in the psychosocial evaluation in patient records #1, 2, 3 and 4.
In patient records 1, 2, 3 and 4, the psychosocial evaluation documentation in the patient record contained standardized language. Staff interviews verified that the facility had a computerized program that permitted them to insert information into the patient report. This practice resulted in a patient evaluation that was not specific to the identification of patient needs, patient strengths, support systems, coping mechanisms, patient attitude toward treatment, negative factors, clinical impressions and overall impressions.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |
715.23(d)(2) LICENSURE Patient records
(d) A narcotic treatment program shall prepare a treatment plan that outlines realistic short and long-term treatment goals which are mutually acceptable to the patient and the narcotic treatment program.
(2) The narcotic treatment physician or the patient 's counselor shall review, reevaluate, modify and update each patient 's treatment plan as required by Chapters 157, 709 and 711 (relating to drug and alcohol services general provisions; standards for licensure of freestanding treatment activities; and standards for certification of treatment activities which are a part of a health care facility).
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Observations
Based on the review of patient records, the narcotic treatment program failed to document treatment plans in four of four patient records.
The findings include:
Four patient records were reviewed on June 4, 2010. Treatment plans were required in all patient records. The narcotic treatment program did not document individualized support services in the treatment plan in patient records #1, 2, 3 and 4.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |