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 and buprenorphine, in the treatment of narcotic addiction. This inspection was conducted on November 5-8, 2012 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, A.R.S. of Lancaster, LP 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.
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Plan of Correction
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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 the review of patient records, the facility failed to document the patient was currently opiate dependent in three of eleven patient records.
The findings include:
Twenty-one patient records were reviewed on November 5-8, 2012. Eleven patient records were reviewed for documentation showing current opiate dependency. Patient records # 4, 7, and 8 failed to document current dependency on the patient's physical examination.
Patient # 4 was admitted on October 5, 2012. The medical director completed the patient's history and physical examination on October 5, 2012. The documentation on the patient's history and physical did not show the patient was currently dependent on opiates. The documentation stated, "chemical dependency, opiate/polysubstance abuse."
Patient # 7 was admitted on October 16, 2012. The medical director completed the patient's history and physical examination on October 16, 2012. The documentation on the patient's history and physical did not show the patient was currently dependent on opiates. The documentation stated, "chemical dependency, opiate/polysubstance abuse."
Patient # 8 was admitted on October 12, 2012. The medical director completed the patient's history and physical examination on October 12, 2012. The documentation on the patient's history and physical did not show the patient was currently dependent on opiates. The documentation stated, "chemical dependency, opiate/polysubstance abuse."
This finding was discussed with the Vice President of Operations and the Facility Director and was not disputed.
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Plan of Correction
Going forward,the physician will clearly document during the admission process that the patient is opiate dependent on the history and physical.
The physician assistant will review each admission to ensure compliance.
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715.13(a) LICENSURE Patient identification
(a) A narcotic treatment program shall use a system for patient identification for the purpose of verifying the correct identity of a patient prior to administration of an agent.
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Observations
Based on observation, the facility failed to follow their policy and procedures for identifying patients prior to administration of methadone.
The findings include:
The facility's policy and procedures were reviewed on November 5, 2012. According to the facility 's policy, "Patients are required to remove sunglasses and hats with visors prior to being medicated. The dispensing nurse will verify that it the correct person by viewing the photo on the computer screen, the patient name, the date of birth and the medication level." Medication dosing was observed on November 7, 201 between 10:10 a.m. and 10:35 a.m. Two dosing windows were open and three patients came to the window wearing hats with visors. The nurses failed to ask the patients to remove their hat to verify their identity with the photo on the computer screen. The patients were not asked identifying questions to verify their date of birth or medication level.
This finding was discussed with the facility director and the director of nursing and was not disputed.
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Plan of Correction
The DON retrained the medical staff on 11/9/12 on the policy and procedure for identify patients prior to administration of methadone. It was reviewed that all patients must remove hats with visor and that identifying information must be confirmed prior to dosing. The DON will be responsible for ensuring this happens with each patient. |