INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection and methadone monitoring inspection conducted on August 21-22, 2018 by staff from the Department of Drug and Alcohol Programs, Bureau of Quality Assurance for Prevention and Treatment, Division of Accountability and Program Improvement. Based on the findings of the on-site inspection, ECHO Treatment Center, LLC was found not to be in compliance with the applicable chapters of 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 orders for medication can be given only by a physician or other medical professional authorized by State and Federal law to prescribe medication and verbal orders may be received only by another physician or medical professional authorized by State and Federal law to receive verbal orders. When a verbal or telephone order is given, it has to be authenticated in writing by a physician or other medical professional authorized by State and Federal law to prescribe medication. In detoxification levels of care, written authentication shall occur no later than 24 hours from the time the order was given. Otherwise, written authentication shall occur within 3 business days from the time the order was given.
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Observations
The facility failed to have the physician sign verbal orders within three business days of the when the order was given in one of one patient record reviewed on August 21-22, 2018.
Record #1 - A Verbal Order was documented on 3/11/18. The verbal order was not signed by a physician.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Facility director has met with all medical personnel and reviewed the deficiency and the plan of correction. The nurse practitioner will be notified of any verbal orders authorized and issued by narcotic treatment physicians and received by medical personnel. Nurse practitioner will ensure that all verbal orders are signed by the prescribing narcotic treatment physician within 3 business days of issuing the order. Nurse practitioner will review all verbal orders to ensure compliance with the regulation. |
709.33 (a) LICENSURE Notification of termination.
§ 709.33. Notification of termination.
(a) Project staff shall notify the client, in writing, of a decision to involuntarily terminate the client ' s treatment at the project. The notice shall include the reason for termination.
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Observations
The facility failed to include the reason for an involuntary termination in the written notice given to the client, in one of one client record reviewed on August 21-22, 2018.
Client # 10 was involuntarily discharged on January 18, 2018. The written notice did not include the reason for the termination.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Upon involuntarily discharging a client from treatment, the written termination notice will include the reason(s) for discharge and will be provided to the client. Clinical supervisor will review all involuntary discharges and ensure that the reason(s) for termination are contained in the written notice of termination. |
709.33 (b) LICENSURE Notification of termination.
§ 709.33. Notification of termination.
(b) The client shall have an opportunity to request reconsideration of a decision terminating treatment.
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Observations
The facility failed to document that the client was given an opportunity to request reconsideration of a decision terminating treatment in one of one client record reviewed on August 21-22, 2018.
Client # 10 was involuntarily discharged on January 18, 2018. There was no documentation the client was given an opportunity to request reconsideration of a decision terminating treatment.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Language stating that the client has a right to appeal his/her involuntary termination from treatment and have the discharge reconsidered within 14 calendar days of termination has been added to the written termination notification form. Clinical supervisor will review all involuntary discharges and ensure that the right to appeal termination language is contained in the written notice of termination. |
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
The facility failed to ensure that each medication order and dosage change was written by the narcotic treatment physician in ten of ten patient records reviewed on August 21-22, 2018.
Patient records # 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 contained documentation of medication orders that were written by someone other than the narcotic treatment physician.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
All physicians orders will be generated and written only by the narcotic treatment physicians unless a verbal order has been received by medical nursing staff. Facility Director has met with all staff including the narcotic treatment physicians and reviewed the regulation. Facility director will perform random and periodic chart audits to ensure this regulation is adhered to. |
715.20(4) LICENSURE Patient transfers
A narcotic treatment program shall develop written transfer policies and procedures which shall require that the narcotic treatment program transfer a patient to another narcotic treatment program for continued maintenance, detoxification or another treatment activity within 7 days of the request of the patient.
(4) The receiving narcotic treatment program shall document in writing that it notified the transferring narcotic treatment program of the admission of the patient and the date of the initial dose given to the patient by the receiving narcotic treatment program.
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Observations
The facility failed to document in writing, that the transfering treatment program was notified of the date of the initial dose given to the patient by the receiving narcotic treatment program in two of four patient records reviewed on August 21-22, 2018.
Patients # 3 and 4 transferred into the facility. The written notification to the transfering treatment program did not include the date of the initial dose given to the patient.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
The written transfer acceptance form has been modified to include the date of initial dose which will be faxed or mailed to the sending narcotic treatment program. Facility director has notified and trained all staff on the modification to the written transfer form. Facility director will perform random and periodic chart audits to ensure that the regulation is adhered to by staff. |