INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection conducted on October 22-23, 2013, by staff from the Program Licensure Division. Based on the findings of the on-site inspection, Discovery House-HA was found not to be in compliance with the applicable chapters of 28 PA Code which pertain to the facility. The following deficiencies were identified during this inspection.
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Plan of Correction
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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.
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Observations
Based on a review of patient records, the facility failed to obtain an informed, voluntary, written consent prior to the administration of a narcotic agent for maintenance treatment.
The findings include:
Nineteen patient records were reviewed on October 22-23, 2013. All patient records were reviewed for the completion of an informed, voluntary written consent prior to the administration of a narcotic agent. The facility failed to document the completion of an informed, voluntary, written consent prior to the administration of a narcotic agent in patient record #19.
Patient # 19 was admitted into treatment on July 23, 2013. The patient received their initial dose of methadone on July 23, 2013. There was no documentation of an informed, voluntary written consent prior to the administration of a narcotic agent in patient record #19.
This finding was confirmed by the facility director. This patient was a readmit to their program and the facility failed to have the patient sign a new consent to treat upon the readmission. The prior consent to treat was signed March 12, 2012.
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Plan of Correction
A training was provided to Medical staff on 10/28/13. The training focused on having a complete record prior to administration of medication. Medical staff will obtain an informed, voluntary, written consent during the initial evaluative appointment. This will be reviewed by MD during his physical evaluation to ensure it is completed before medication begins. Program Director will complete chart reviews monthly to ensure compliance starting 10/28/13.
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715.17(a) LICENSURE Medication control
(a) A narcotic treatment program shall comply with applicable Federal and State statutes and regulations regarding the storing, compounding, administering and dispensing of medication.
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Observations
Based on the review of patient records, the facility failed to ensure the narcotic treatment physician complied with applicable Federal and State statues and regulations regarding the storing, compounding, administering and dispensing of medication.
The findings include:
Nineteen patient records were reviewed on October 22-23, 2013. Five records reviewed were receiving Suboxone services at the facility. Documentation in patient record #10 revealed the narcotic treatment physician wrote an order that allowed for the patient to cut a suboxone strip in half. The order read: 1 and 1/2 films daily. The suboxone packaging states that each strip is a dose. There are no score lines on the strip that allow for this medication to be cut into half doses.
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Plan of Correction
Effective 10/28/13 Discovery House Medical Director and all Physicians will follow manufactures recommendations for administering and prescribing medications. Alternative milligram doses will be prescribed instead of offering the ability to cut the medication. Program Director will monitor via chart audits on a quarterly basis to ensure compliance. |
709.91(b)(3)(i) LICENSURE Intake and admission
709.91. Intake and admission.
(b) Intake procedures shall include documentation of:
(3) Histories, which include the following:
(i) Medical history.
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Observations
Based on the review of patient records, the facility failed to document a complete personal history in seven of nine records reviewed.
The findings include:
Nineteen patient records were reviewed on October 22-23, 2013. Nine patient records were reviewed for a complete personal history. Patient records # 2, 4, 5, 6, 8, 14, and 19 lacked detail in the personal histories by answering with one or two word answers.
Patient # 2 was admitted on August 9, 2013. The facility failed to document a detailed educational history.
Patient # 4 was admitted on August 23, 2013. The facility failed to document a detailed educational history.
Patient # 5 was admitted on September 3, 2013. The facility failed to document a detailed legal and educational history.
Patient # 6 was admitted on September 19, 2013. The facility failed to document a detailed legal history.
Patient # 8 was admitted on August 5, 2013. The facility failed to document a detailed educational history.
Patient # 14 was admitted on August 14, 2013. The facility failed to document a detailed educational history.
Patient # 19 was admitted on July 23, 2013. The facility failed to document a detailed legal history.
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Plan of Correction
A training will be Provided on 10/28/13 to clinical staff by the Clinical Supervisor on documenting personal histories to include educational histories and legal histories. Clinical Supervisor to conduct individualized training during supervision as well with all staff to ensure compliance. Clinical Supervisor to review all intake assessments to ensure compliance starting 10/28/13. Program Director to conduct quarterly audits to ensure compliance. |