INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection and inspection conducted for the approval to use a narcotic agent, specifically, buprenorphine, in the treatment of narcotic addiction. This inspection was conducted on September 17, 2015, by staff from the Department of Drug and Alcohol Programs, Program Licensure Division. Based on the findings of the on-site inspection, Pyramid Healthcare, Inc 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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709.32(b) LICENSURE Medication Control
709.32. Medication control.
(b) Verbal medication orders may be accepted but shall be put in writing and signed within 24 hours thereafter by the prescribing physician.
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Observations
Based on the review of client records, the facility failed to document that verbal orders were signed by the prescribing physician within three business days, in two of two client records.
The findings include:
Ten client records were reviewed on September 17, 2015. Two client records documented verbal orders. The facility did not document that verbal orders were signed within the required timeframe by the prescribing physician in client records # 1 and 6.
Client # 1 was admitted on May 24, 2015. Verbal orders, dated 6/6/15 and 9/1/15, were signed by the prescribing physician. The date and time of the physician's signature was not documented.
Client # 6 was admitted on February 1, 2015. Verbal orders, dated 6/26/15 and 8/21/15, were signed by the prescribing physician. The date and time of the physician's signature was not documented.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Physicians and Nurses will be trained by the Director of Nursing on proper documentation of verbal orders including the signing and dating by the Physician within three business days. This will be completed by October 1, 2015. The Nursing staff will be trained by the Director of Nursing to review all verbal orders for accuracy and completion prior to completion of their shift beginning on October 1, 2015. This training will be completed by October 1, 2015. By October 23, 2015 the Physicians and Nurses will be trained by the Director of Nursing in the use of visual cue stickers that are to be placed on the verbal orders to indicate proper Physician signature and dating procedure has been followed. The Nurse will review the verbal order stickers prior to completion of each shift. Monthly chart monitors completed by the Director of Nursing will include this item beginning with October 2015 chart monitors. |
715.15(b) LICENSURE Medication dosage
(b) The narcotic treatment physician shall determine the proper dosage level for a patient, except as otherwise provided in this section. If the narcotic treatment physician determining the initial dose is not the narcotic treatment physician who conducted the patient examination, the narcotic treatment physician shall consult with the narcotic treatment physician who performed the examination before determining the patient 's initial dose and schedule.
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Observations
Based on the review of client records, the facility failed to document that the narcotic treatment physician determined the proper dosage level for a patient in one of six client records.
The findings include:
Ten client records were reviewed on September 17, 2015. Six client records were reviewed as buprenorphine records. There was no documentation that the narcotic treatment physician determined the proper dosage level for the client in client record # 5.
Client # 5 was admitted on November 24, 2014. A prescription for buprenorphine, written on 12/29/14 was for a quantity of 14 films, to be taken twice a day and had 5 refills. The total days of the prescription was 42. A prescription would have been due by February 8, 2015. There was no prescription documented on this date. The next prescription was dated February 12, 2015. There was documentation that the client had seen the narcotic treatment physician on January 5, 12, 19, 27, February 2 and 9, 2015. There was no documentation that the client's prescription had been suspended or that the client was being detoxed.
A prescription for buprenorphine, written on May 1, 2015 was for a quantity of 14 films, to be taken twice a day and had 5 refills. The prescription was written with one week remaining on the previous prescription, good until May 8, 2015. The total days of the new prescription was 42. From May 8, 2015, a prescription would have been due by June 19, 2015. There was no prescription documented on this date. The next prescription was dated July 3, 2015. There was documentation that the client had seen the narcotic treatment physician on May 8, 15, 22, 29, June 8,12 and 19, 2015. There was no documentation that the client's prescription had been suspended or that the client was being detoxed.
A prescription for buprenorphine, written on July 3, 2015, was for a quantity of 14 films, to be taken twice a day and had 5 refills. The total days of the prescription was 42. A prescription would have been due by August 7, 2015. There was no prescription documented on this date. The next prescription was dated September 1, 2015. There was documentation that the client had seen the narcotic treatment physician on July 10, 17 and 31, 2015. There was no documentation that the client's prescription had been suspended or that the client was being detoxed.
These findings were reviewed with facility staff.
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Plan of Correction
Physicians and Nurses will be trained by the Director of Nursing on the procedure for documenting proper dosage level by the narcotic treatment Physician. This will be completed by October 1, 2015. The Nursing staff will be trained by the Director of Nursing to review the documentation for proper dosage level by the narcotic treatment Physician prior to the completion of each shift. This training will be completed by October 1, 2015. Monthly chart monitors completed by the Director of Nursing will include this item beginning with October 2015 chart monitors.
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