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 January 809, 2014 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Discovery House 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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715.16(a)(1) LICENSURE Take-home privileges
(a) A narcotic treatment program shall determine whether a patient may be provided take-home medications.
(1) A narcotic treatment program may give take-home medications only to a patient who the narcotic treatment physician has determined is responsible and able to handle narcotic drugs outside the narcotic treatment program.
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Observations
Based on the review of patients records, the facility failed to document that the narcotic treatment physician determined the client's take-home medications status in one of six patient records.
The findings include:
Nineteen patient records were reviewed on January 8-9, 2014. Six patient records reviewed had take homes medication privileges. The facility did not document that the narcotic treatment physician determined the patient's take home medication status in patient record # 13.
Patient # 13 was admitted on September 9, 2011. Documentation of a team meeting, dated October 4, 2013 stated that the patient was approved for tri- weekly take homes. There was no documentation that the narcotic treatment physician was present at this meeting. The narcotic treatment physician's signature was dated October 7, 2013. Documentaiton indicated that the clinical staff had made the determination regarding the patient's take home medication privileges.
The Facility Director was interviewed on January 9, 2014 and did not dispute the findings.
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Plan of Correction
715.16(a) Staff recording notes of Multi Disciplinary Team meetings (MDTs) will record those staff and patients who are present. The Eight Point form has been revised as follows:
1. Included a section for meeting attendance.
2. "Approved" at the end of the form be changed to "Approved by Physician".
Language in meeting notes will reflect the fact that the physician is the one making the decision to grant take home privileges. The Clinical Supervisor is responsible for training (training held on January 16, and repeated January 29, 2014) and monitoring recording of notes concerning this correction. The physician order will contain clear language showing he has made the decision.
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715.16(a)(4) LICENSURE Take-home privileges
(a) A narcotic treatment program shall determine whether a patient may be provided take-home medications.
(4) A narcotic treatment physician may rescind take-home medication privileges.
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Observations
Based on the review of patients records, the facility failed to document that the narcotic treatment physician determined the rescinding of a patient's take home medication privileges in one of six patient records.
The findings include:
Nineteen patient records were reviewed on January 8-9, 2014. Six patient records reviewed had take homes medication privileges. The facility did not document that the narcotic treatment physician determined the patient's take home medication status in patient record # 14..
Patient # 14 was admitted on November 19, 2012. Documentation of a medical note, signed and dated December 10, 2013, by nursing staff, stated that the patient's take home privileges will be withheld. There was no documentation that the narcotic treatment physician had been contacted. The narcotic treatment physician's signature was dated December 19, 2013. Documentation indicated that clinical staff had made the determination to rescind the patient's take home medication privileges
A team meeting note, signed and dated December 23, 2013 by clinical staff, stated that the patient's take home medication privileges would be reinstated. There was no documentation that the narcotic treatment physician had been present at that meeting. The narcotic treatment physician's signature was dated December 24, 2013. Documentation indicated that clinical staff had made the determination to reinstate the patient's take home medication privileges
The Facility Director was interviewed on January 9, 2014 and did not dispute the findings.
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Plan of Correction
715.16(a)(4) Only the DHBC physician will decide that take home privileges are being revoked or reinstated. Other staff may record a note of a revocation or reinstatement decision, with the note indicating the determination was made by the physician. The physician will sign orders prior to take homes being rescinded or reinstated. The Clinical Supervisor and the Nurse Manager are responsible for training (training held on January 16, and repeated January 29, 2014) and monitoring their respective staff in implementing this correction. The physician is responsible for timely signing of forms and orders prior to the rescinding or reinstatement of take home privileges. |