INITIAL COMMENTS
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This report is a result of an onsite licensure renewal and methadone monitoring inspection. The inspection was conducted on September 21 - 22, 2017 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the onsite inspection, Alliance Medical Services 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 the inspection:
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Plan of Correction
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709.32 (b) LICENSURE Medication control
§ 709.32. Medication control.
(b) Verbal orders for medication can be given only by a physician or other medical professional authorized by State and Federal law to prescribe medication and verbal orders may be received only by another physician or medical professional authorized by State and Federal law to receive verbal orders. When a verbal or telephone order is given, it has to be authenticated in writing by a physician or other medical professional authorized by State and Federal law to prescribe medication. In detoxification levels of care, written authentication shall occur no later than 24 hours from the time the order was given. Otherwise, written authentication shall occur within 3 business days from the time the order was given.
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Observations
The facility failed to document a verbal order was signed by the physician within three business days during a review of patient records on September 22, 2017. Patient #4 was admitted to treatment on 3-1-2017. A verbal order was given on 3-3-2017 and was signed by the physician on 3-7-2017. These findings were reviewed with the facility staff during the licensing process.
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Plan of Correction
All medical orders musts be given by the Physician and received by program Nurse.
Orders may be given or changed over the phone or verbally by the physician. The nurse must record the order on the Doctor's order sheet. In order to assure accuracy s/he must repeat the order back to the physician. The nurse must sign and date the order. The physician must counter-sign the order within 3 days; faxed orders may be entered into the record if printed on indelible paper stock.
Verbal orders will be tracked by PA in the SMART system to make sure they are signed off on within the 3 day time frame.
No employee other than the staff nurse is allowed under law to accept and document a change in orders from the physician.
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715.19(1) LICENSURE Psychotherapy services
A narcotic treatment program shall provide individualized psychotherapy services and shall meet the following requirements:
(1) A narcotic treatment program shall provide each patient an average of 2.5 hours of psychotherapy per month during the patient 's first 2 years, 1 hour of which shall be individual psychotherapy. Additional psychotherapy shall be provided as dictated by ongoing assessment of the patient.
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Observations
The facility failed to provide 2.5 hours of psychotherapy services for one of five patient records reviewed on September 22, 2017. Patient #8 was admitted to treatment on 6-14-2017. The patient received less than 2.5 hours of services for August 2017.The findings were reviewed with the facility staff during the licensing process.
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Plan of Correction
The facility failed to provide 2.5 hours of psychotherapy services for one of five patient records reviewed
The facility will ensure that all patients receive the required of monthly psychotherapy. Monitoring of ongoing compliance with this regulation will be the responsibility of the Supervisory Staff through regular record review, clinical supervision, and utilization for SMART reports.
Supervisory Staff will meet with program staff in treatment team meeting and review all regulation requirements related to individualized psychotherapeutic needs.
Facility Staff will utilize SMART reports to periodically check counseling compliance for their caseloads.
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