INITIAL COMMENTS
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This report is a result of an onsite follow-up inspection pertaining to the plans of correction for the July 12, 2011 through July 14, 2011 methadone and buprenorphine monitoring inspection. The follow-up inspection was conducted on December 29, 2011 by staff from the the Division of Drug and Alcohol Program Licensure. Based on the findings of the onsite follow-up inspection, BGI of Brandywine, Inc. 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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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 a review of patient records, the facility failed to obtain an informed, voluntary, written consent prior to the administration of a narcotic agent for maintenance treatment in one of three patient records.
The findings include:
Eleven patient records were reviewed on December 29, 2011. Three patient records were reviewed for the completion of an informed, voluntary written consent prior to the administration of a narcotic agent. The facility failed to document the completion of an informed, voluntary, written consent prior to the administration of a narcotic agent in patient record # 6.
Patient # 6 was admitted into treatment on November 11, 2011. The patient received their initial dose of methadone on November 12, 2011 at 14:00 p.m. There was no documentation of an informed, voluntary written consent prior to the administration of a narcotic agent in patient record # 6.
The assistant director of nursing was interviewed on December 29, 2 011 and confirmed this finding.
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Plan of Correction
All Nursing Staff will be re-educated regarding this standard as of 1/27/2012. The "Methadone Administration Checklist" form has been ammended to include "Methadone consent signed" as a mandatory check before a patient is dosed.
Random chart audits will be done by DON and/or ADON or designee per shift to assure ongoing compliance with this standard. |
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 a review of patient records, the facility failed to ensure that the patient was initially dosed following the completion of a drug-screen urinalysis in one of two patient records.
The findings included:
Eleven patient records were reviewed on December 29, 2011. Two patient records were reviewed for drug screen urinalysis results prior to a patient's initial dose. The facility failed to document the completion of a drug-screen urinalysis prior to medication induction in patient record # 5.
Patient # 5 was admitted into treatment on December 10, 2011. Patient # 5 received a dose of 20 mg on December 11, 2011, the same date that the patient had submitted a urine specimen for a drug-screen urinalysis. The test results were not returned until December 13, 2011 at 07:56 a.m. This patient received their initial dose of methadone prior to the urinalysis test results were returned.
The assistant director of nursing was interviewed and confirmed this finding.
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Plan of Correction
All Nursing Staff will be re-educated regarding this standard as of 1/27/2012. The "Methadone Administration Checklist" form has been ammended to include "Urine Screen collected/received" as a mandatory check before a patient is dosed. Random chart audits will be done by DON and/or ADON or designee per shift to assure ongoing compliance with this standard.
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715.15(b) LICENSURE Medication dosage
(b) The narcotic treatment physician shall determine the proper dosage level for a patient, except as otherwise provided in this section. If the narcotic treatment physician determining the initial dose is not the narcotic treatment physician who conducted the patient examination, the narcotic treatment physician shall consult with the narcotic treatment physician who performed the examination before determining the patient 's initial dose and schedule.
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Observations
Based on the review of patient records, the facility failed to document that a consultation took place between the physician who determined the initial dose and the the Physician Assistant who completed the physical examination in two of two records.
The findings include:
Eleven patient records were reviewed December 29, 2011. Two records were reviewed for documentation that a consultation took place between the narcotic treatment physician and the Physician's Assistant ( PA-C) prior to the physician's determination of the patient's initial dose and schedule.
Patient # 9 was admitted 12/26/2011. The doctor documented a face to face with the patient on 12/27/2011, but failed to indicate that the narcotic treatment physician consulted with the PA-C who completed the history and physical examination on the patient. The patient received a physical examination by the PA-C on 12/27/2011. The patient received their first dose of 20 mg methadone at 13:30 p.m. on 12/27/2011. The PA-C documented that she consulted with the physician; however, the documentation needed to indicate that the narcotic treatment physician consulted with the Physician 's Assistant.
Patient # 10 was admitted on 12/28/2011. The doctor documented a face to face with the patient on 12/28/2011, but failed to indicate that the narcotic treatment physician consulted with the PA-C who completed the history and physical examination on the patient. The patient received a physical examination by the PA-C on 12/28/2011. The patient received their first dose of 175 mg methadone at 15:40 p.m. on 12/28/2011. The PA-C documented that she consulted with the physician; however, the documentation needed to indicate that the narcotic treatment physician consulted with the Physician 's Assistant
This is a repeat citation form the methadone and buprenorphine monitoring inspection conducted on July 12, 2011 through July 14, 2011.
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Plan of Correction
Narcotic Treatment Physician(s) and Physican Assistant re-educated regarding this standard as of 1/27/2012.
In all cases, the consult between a Narcotic Treatment Physican and the Physican Assisant, will be documented by the Narcotic Treatment Physician prior to determining patient's dose and ultimately the patient being dosed.
Random chart audits will be done by DON and/or ADON or designee per shift to assure ongoing compliance with this standard.
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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
Based on the review of patient records, the facility failed to document that it notified the referring facility of the admission and initial dosing of the patient in one of two patient records.
The findings include:
Eleven patient records were reviewed December 29, 2011. Two patient records were reviewed for documentation of notification to the referring facility of the admission and dosing of the referred patient.
Patient record #6 was referred by another narcotic treatment program and there was no documentation of the referral being notified of the admission and initial dosing of the patients.
An interview with the assistant director of nursing confirmed this finding.
This is a repeat citation form the methadone and buprenorphine monitoring inspection conducted on July 12, 2011 through July 14, 2011.
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Plan of Correction
All Nursing Staff will be re-educated regarding this standard as of 1/27/2012. The "Methadone Administration Checklist" form has been ammended to include "Notification to referring agency" as a mandatory check before a patient is dosed. Random chart audits will be done by DON and/or ADON or designee per shift to assure ongoing compliance with this standard.
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