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 October 18-20, 2011 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Dolminis 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)(2) LICENSURE Take-home privileges
(a) A narcotic treatment program shall determine whether a patient may be provided take-home medications.
(2) The narcotic treatment physician shall make this determination after consultations with staff involved in the patient's care.
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Observations
Based on the review of patient records, the facility failed to document that the narcotic treatment physician consulted with staff involved in the patient's care prior to determining that a patient was appropriate for take-home medication in one of six patient records.The findings include:Thirty patient records were reviewed on October 18-20, 2011. Six patient records were reviewed for take home medication documentation. Patient # 9 was transferred from a narcotic treatment program and admitted into treatment on September 9, 2011. The patient was immediately permitted 6 day take-home medication. There was no documentation that the narcotic treatment physician consulted with staff involved in the patient's care prior to permitting the take-home medication. The facility director was interviewed on October 19, 2011 and confirmed the findings.
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Plan of Correction
Medical director will document his review of previous records and consultation with staff prior to permitting take-homes when patient is admitted with privileges.
Compliance will be monitored through random monthly chart audits conducted by nursing staff and program director.
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715.16(a)(3) LICENSURE Take-home privileges
(a) A narcotic treatment program shall determine whether a patient may be provided take-home medications.
(3) The narcotic treatment physician shall document in the patient record the rationale for permitting take-home medication.
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Observations
Based on the review of patient records, the facility failed to ensure the physician documented in the patient record the rationale for granting take home medication in one of six patient records.The findings include:Thirty patient records were reviewed on October 18-20, 2011. Six patient records were reviewed for take home medication documentation. Patient record # 9 did not document the narcotic treatment physician's rationale for permitting take home medication. The facility director was interviewed on October 19, 2011 and confirmed the findings.
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Plan of Correction
Medical director will document his rationale for permitting take home medication.
Compliance will be monitored through random monthly chart audits conducted by nursing staff and program director.
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715.16(d)(1-3) LICENSURE Take-home privileges
(d) A narcotic treatment program may make exceptions to the requirements in subsection (c) relating to the length of time of satisfactory adherence to narcotic treatment program rules and number of days of take-home medication when, in the reasonable clinical judgment of the narcotic treatment physician, which is documented in the patient record:
(1) A patient has a permanent physical disability.
(2) A patient has a temporary disability.
(3) A patient has an exceptional circumstance such as illness, personal or family crisis, or travel which interferes with the patient 's ability to conform to the applicable mandatory attendance schedules. In all cases, the patient shall demonstrate an ability to responsibly handle narcotic drugs.
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Observations
Based on the review of the patient records, the facility failed to maintain documentation of an exception relates to a specific patient in one of one patient record. The findings include:Thirty patient records were reviewed on October 18-19, 2011. One patient record required an exception for take-home medication for medical reasons. Patient # 11 was admitted on January 25, 2010. On September 27, 2011, the patient's counselor submitted an exception for the patient to receive 6 day take- home medication for take-home surgery. The counselor documented in the take-home medication request only that the patient was to undergo knee surgery on October 4, 2011. The narcotic treatment physician approved the request on September 28, 2011. There was no confirmation of the surgery documented, other than the patient's statement, of the patient's surgery nor that the patient would not be be able to attend daily dosing. The facility director was interviewed on October 19, 2011 and confirmed the findings.
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Plan of Correction
Prior to granting an exception for take-home medication for medical reasons medical director will review and document confirmation of the temporary medical condition that warrants request.
Nursing staff or program director will monitor for compliance by confirming existence of needed documentation for all exception take-home dose orders.
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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 observation of the dosing windows, the facility failed to administer and dispense medication in a manner that protected the patient from disruption or annoyance from other individuals.The findings include: At approximately 8:15 AM on October 19, 2011, a small child and an adult female were observed in the dosing area. The adult female left the dosing window during her dosing to tend to the child. On October 20, 2011, at approximately 8:30 AM, a small child was observed running to an adult female at the dosing window. The adult female left the dosing window to tend to the small child. The presence of the children at the dosing window did not protect the patients from disruption or annoyance from other individuals.
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Plan of Correction
Patients will be reminded of dosing procedures during group sessions and a sign will be placed at dosing stations reminding patients that children are not permitted in dosing area. Dosing procedures will continue to be addressed during orientation group.
Compliance will be monitored and assistance provided by all staff.
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