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 Buprenorphine, in the treatment of narcotic addiction. This inspection was conducted on February 10, 2014 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Pyramid Healthcare, Inc- Transitions II 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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715.9(a)(4) LICENSURE Intake
(a) Prior to administration of an agent, a narcotic treatment program shall screen each individual to determine eligibility for admission. The narcotic treatment program shall:
(4) Have a narcotic treatment physician make a face-to-face determination of whether an individual is currently physiologically dependent upon a narcotic drug and has been physiologically dependent for at least 1 year prior to admission for maintenance treatment. The narcotic treatment physician shall document in the patient 's record the basis for the determination of current dependency and evidence of a 1 year history of addiction.
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Observations
Based on the review of patient records, the facility failed to document a face to face determination of whether an individual is currently physiologically dependent upon a narcotic drug in one of seven patient records.
The findings include:
Seven patient records requiring a face to face determination of whether an individual is currently physiologically dependent upon a narcotic drug were reviewed on February 10, 2014. The facility failed to document the face to face determination in patient record # 7.
Patient # 7 was admitted on October 11, 2013. As of February 10, 2014, the facility failed to document a face to face determination that the patient is currently physiologically dependent upon a narcotic drug.
The Director of Nursing was interviewed on February 10, 2014 and confirmed the findings.
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Plan of Correction
The Director of Nursing will review the requirement of a physician face-to-face determination of physiological dependancy upon a narcotic drug with the attending physicians. The Director of Nursing will review the requirement with nursing staff and have staff monitor to ensure completion before medical detoxification protocols are initiatied with clients. |
715.12(1-5) LICENSURE Informed patient consent
A narcotic treatment program shall obtain an informed, voluntary, written consent before an agent may be administered to the patient for either maintenance or detoxification treatment. The following shall appear on the patient consent form:
(1) That methadone and LAAM are narcotic drugs which can be harmful if taken without medical supervision.
(2) That methadone and LAAM are addictive medications and may, like other drugs used in medical practices, produce adverse results.
(3) That alternative methods of treatment exist.
(4) That the possible risks and complications of treatment have been explained to the patient.
(5) That methadone is transmitted to the unborn child and will cause physical dependence.
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Observations
Based on the review of patient records, the facility failed to obtain a written consent before an agent was administered to the patient for detoxification treatment that included: that the narcotic drugs can be harmful if taken without medical supervision, that alternative methods of treatment exist and that the possible risks and complications of treatment had been explained to the patient, in three of seven patient records.
The findings include:
Seven patient records requiring documentation of a written consent before an agent was administered to the patient for detoxification treatment were reviewed on February 10, 2014. The facility failed to document a written consent that included that the narcotic drugs can be harmful if taken without medical supervision, that alternative methods of treatment exist and that the possible risks and complications of treatment had been explained to the patient in patient records # 4, 6 and 7.
Patient # 4 was admitted on November 29, 2013. A written consent signed by the patient on November 29, 2013 did not include that the narcotic drugs can be harmful if taken without medical supervision, that alternative methods of treatment exist and that the possible risks and complications of treatment had been explained to the patient.
Patient # 6 was admitted on September 5, 2013. A written consent signed by the patient on September 5, 2013 did not include that the narcotic drugs can be harmful if taken without medical supervision, that alternative methods of treatment exist and that the possible risks and complications of treatment had been explained to the patient.
Patient # 7 was admitted on October 11, 2013. A written consent signed by the patient on October 11, 2013 did not include that the narcotic drugs can be harmful if taken without medical supervision, that alternative methods of treatment exist and that the possible risks and complications of treatment had been explained to the patient.
The Director of Nursing was interviewed on February 10, 2014 and confirmed the findings.
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Plan of Correction
The Program Director will review the requirement of obtaining a written consent before an agent is administered to a client for detoxification treatment with Intake staff. The Director of Nursing will review the requirement with nursing staff to ensure that the written consent is signed before a detoxification agent is administered to a client. |
715.14(a) LICENSURE Urine testing
(a) A narcotic treatment program shall complete an initial drug-screening urinalysis for each prospective patient and a random urinalysis at least monthly thereafter.
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Observations
Based on the review of patient records, the facility failed to obtain a complete drug screen urinalysis prior to the administration of a narcotic agent, in four of seven patient records.
The findings include:
Seven patient records were reviewed on February 10, 2014. Seven patient records were required to have a complete drug screen prior to the administration of a narcotic agent. The facility failed to obtain a complete drug screen urinalysis' prior to the administration of a narcotic agent in patient records # 1, 2, 3, and 4.
Patient # 1 was admitted on February 8, 2014. The initial dose of a narcotic agent was given on February 9, 2014. The initial drug screen urinalysis results were not reported until February 10, 2014.
Patient # 2 was admitted on February 8, 2014. The initial dose of a narcotic agent was given on February 9, 2014. The initial drug screen urinalysis results were not reported until February 10, 2014.
Patient # 3 was admitted on February 7, 2014. The initial dose of a narcotic agent was given on February 7, 2014. The initial drug screen urinalysis results were not reported until February 8, 2014.
Patient # 4 was admitted on November 29, 2013. The initial dose of a narcotic agent was given on November 30, 2013. The initial drug screen urinalysis results were not reported until December 1, 2013.
The Director of Nursing was interviewed on February 10, 2014 and confirmed the findings.
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Plan of Correction
The Program Director and Director of Nursing will initiate the process of gaining exception for onsite urinalysis screening. In the interim, the Director of Nursing will review and have nursing staff acknowledge understanding of the current policy on administration of narcotic agents and monitor protocol to ensure clients are not dosed prior to results of a laboratory urinalysis. |
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 a review of patient records, the facility failed to ensure that verbal medication orders were put in writing and signed with 24 hours thereafter by the prescribing physician in one of one patient records.
The findings include:
Seven buprenorphine detoxification patient records were reviewed on February 10, 2014. One patient record reviewed contained documentation of a verbal medication order. The facility failed to ensure that the verbal medication order was signed by the prescribing physician in patient record # 2.
Patient # 2 was admitted on February 8, 2014. The record included a verbal medication order that was received on February 9, 2014 at 12:30 P.M.. The facility failed to have the verbal medication order signed by the prescribing physician. Instead, the verbal medication order was signed within 24 hours by the medical director, who was not the prescribing physician.
The Director of Nursing was interviewed on February 10, 2014 and did not dispute the findings.
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Plan of Correction
The Director of Nursing will review the requirement of the prescribing physician signing his/her own verbal orders with the attending physicians. The Director of Nursing will review and have nursing staff acknowledge understanding and ensure that nursing staff monitor the attending physicians adherence to this requirement and report any exceptions to the Director of Nursing. |