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 November 7 & 10, 2014, by staff from the Program Licensure Division of the Department of Drug and Alcohol Programs. Based on the findings of the on-site inspection, Alliance Medical Services 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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715.17(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 a review of the patient records, the facility failed to document that each medication order included a schedule change, and was written and signed by the narcotic treatment physician.
The findings include:
Twelve patient records were reviewed on November 7 & 10, 2014. Ten were applicable for the physician to communicate schedule changes. The schedule changes are to be written and signed by the narcotic treatment physician.
Patient #4 was admitted to treatment on September 4, 2013. Take home privileges were granted but the narcotic treatment physician did not document and sign the schedule changes.
Patient #10 was admitted to treatment on February 4, 2010. Take home privileges were granted but the narcotic treatment physician did not document and sign the schedule changes.
These findings were reviewed with the facility staff during the licensing process.
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Plan of Correction
Medical Director will record approved take home schedule on the Physician Order Form in addition to the take home justification form for each change in take home schedule. To ensure on going compliance, the Facility Director will review 10 random charts of patients with take home approval monthly to ensure proper documentation. This process will be effective immediately. |
715.23(b)(4) LICENSURE Patient records
(b) Each patient file shall include the following information:
(4) The results of an initial intake physical examination.
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Observations
Based on a review of the patient records, the facility failed to document the narcotic treatment physician signed the physical examination.
The findings include:
Twelve patient records were reviewed on November 7 & 10, 2014. Six were applicable for the physician to sign the physical examination when the physician assistant completes the examination.
Patient #1 was admitted to treatment on November 12, 2013. The physical examination was completed on November 7, 2013 by the physician assistant. The narcotic treatment physician did not sign the physical examination.
Patient #11 was admitted to treatment on May 21, 2014. The physical examination was completed on May 21, 2014 by the physician assistant. The narcotic treatment physician did not sign the physical examination.
Patient #12 was admitted to treatment on May 22, 2014. The physical examination was completed on May 22, 2014 by the physician assistant. The narcotic treatment physician did not sign the physical examination.
These findings were reviewed with the facility staff during the licensing process.
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Plan of Correction
Medical Director will review and countersign all physicals completed by the Physician's Asst. To ensure compliance, The Facility Director will review all intake physicals monthly to ensure this practice is being followed. |