Observations
Based on the review of patient records, the facility failed to obtain a complete initial drug screen urinalysis prior to the administration of Suboxone, a narcotic agent, in six of nine patient records.
The findings include:
Nine patient records were reviewed on January 16, 2014. The facility was required to include documentation of a complete initial drug screen urinalysis in all nine patient records. A complete initial drug screen included receiving the results of the initial drug screen urinalysis from the CLIA and Department of Health approved laboratory. The facility failed to document a complete initial drug screen urinalysis prior to the administration of Suboxone, a narcotic agent, in patient records # 1, 3, 4, 6, 7 and 8.
Patient # 1 was admitted on December 16, 2013. Patient # 1 was given the initial dose of Suboxone on 12/17/13 at 6:00. The initial drug screen urinalysis results were not received from the laboratory until 12/18/13.
Patient # 3 was admitted on December 23, 2013. Patient # 3 was given the initial dose of Suboxone on 12/26/13 at 12:40. There were no initial drug screen urinalysis results documented in patient record #3.
Patient # 4 was admitted on April 3, 2013. Patient # 4 was given the initial dose of Suboxone on 4/4/13 at 5:00. The initial drug screen urinalysis results were not received from the laboratory until 4/9/13.
Patient # 6 was admitted on July 9, 2013. Patient # 6 was given the initial dose of Suboxone on 7/10/13 at 7:30. The initial drug screen urinalysis results were not received from the laboratory until 7/11/13.
Patient # 7 was admitted on November 20, 2013. Patient # 7 was given the initial dose of Suboxone 11/21/13 at 1:15. The initial drug screen urinalysis results were not received from the laboratory until 11/22/13.
Patient # 8 was admitted on December 23, 2013. Patient # 8 was given the initial dose of Suboxone on 12/24/13 at 5:40. There were no initial drug screen urinalysis results documented in patient record # 8.
The findings were discussed with the facility director and were not disputed.
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Plan of Correction
Initial urine drug screens are completed on all opioid dependent patients upon admission and results, per our current contract with Quest Labs, are received within 24 hours which is before they are administered the first dose of Buprenorphine.
This process has been in compliance since 1/16/14 and will be monitoring on an on-going basis by the Director of Detox and Nursing Services.
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