Observations
Based on a review of patient records and an interview with the interim medical director and physician assistant, the facility failed to 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 and administration of an agent in three of fifteen patient records.The findings include:Thirty patient records were reviewed on March 14 -15, 2011. The intake medical documentation was reviewed in fifteen of the thirty patient records reviewed. The facility did not document that the narcotic treatment physician made 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 and administration of an agent in patient records # 9, 10 and 20.Patient #9 was admitted on November 18, 2010 and given an initial dose of methadone on the same day. The patient's physical examination was completed by the physician assistant also on November 18, 2010. The document that was signed by the narcotic treatment physician which establishes the patient's physiological dependence upon a narcotic drug and one year history thereof was signed by the narcotic treatment physician on November 22, 2010.Patient #10 was admitted on August 10, 2010 and given an initial dose of methadone August 11, 2010. The patient's physical examination was completed by the physician assistant on August 10, 2010. The document that was signed by the narcotic treatment physician which establishes the patient's physiological dependence on a narcotic drug and one year history thereof was signed by the narcotic treatment physician on August 16, 2010.Patient #20 was admitted on November 17, 2010 and given an initial dose of methadone on the same day. The patient's physical examination was completed by the physician assistant also on November 17, 2010. The document that was signed by the narcotic treatment physician which establishes the patient's physiological dependence upon a narcotic drug and one year history thereof was signed by the narcotic treatment physician on November 22, 2010.An interview with the interim medical director and the physician assistant was conducted on March 15, 2011. It was reported at that time that the physician is meeting with the patient prior to dosing and the current and 1 year physiological dependence is being determined by the physician prior to the administration of the initial dose; however, it was confirmed that in the above mentioned patient records, the documentation was signed by the physician at a later date.
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Plan of Correction
The facility did not provide the physician's determination of opiate dependency prior to admission.
The Physician is required to make the determination of opiate dependency prior to any admission to MAT.
The signed determination of dependency will be signed by the Physician prior to admission and placed in the pt. medical record.
The Physician is responsible for this requirement. The Physician Assistant will monitor all new patient charts in order to assess compliance.
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