Observations
Based on a review of patient records, the facility failed to ensure that the narcotic treatment physician determined dose changes in accordance with the regulations and facility policy in five of eleven patient records.
The findings include:
Twenty patient records were reviewed on July 24-26, 2012. Eleven patient records were reviewed for the physician's documentation in determining the initial and subsequent dose of methadone. These records revealed that the physician was making determinations of incremental increases without direct assessment of the patient. The facility did not document that the narcotic treatment physician determined the proper dosage level in patient records # 2, 6, 7, 8 and 13.
Patient #2 received an initial dose on May 7, 2012. Documented in patient record #2 was an order by the physician dated May 15, 2012 that included a standing order to increase the patient dosage 5 mg daily for the next two days to 40 mg. Another order dated May 17, 2012 included a standing order to increase the patient dosage 5 mg daily for the next two days to 50 mg. There was no documentation that the narcotic treatment physician continued to assess the patient to determine if an increase in the patient's dose was needed.
Patient #6 received an initial dose on March 8, 2012. Documented in patient record #6 was an order by the physician dated April 13, 2012 that included a standing order to increase the patient dosage 5 mg daily for the next two days to 60 mg. Another order dated May 7, 2012 included a standing order to increase the patient dosage 5 mg daily for the next three days to 80 mg. There was no documentation that the narcotic treatment physician continued to assess the patient to determine if an increase in the patient's dose was needed.
Patient #7 received an initial dose on April 30, 2012. Documented in patient record #7 was an order by the physician dated May 2, 2012 that included a standing order to increase the patient dosage 5 mg daily for the next two days to 40 mg. A subsequent order dated May 7, 2012 included a standing order to increase the patient dosage 5 mg daily for the next three days to 55 mg. Another order dated May 14, 2012 included a standing order to increase the patient dosage 5 mg daily for the next two days to 65 mg. Lastly, an order dated May 21, 2012 included a standing order to increase the patient dosage 5 mg daily for the next two days to 75 mg. There was no documentation that the narcotic treatment physician continued to assess the patient to determine if an increase in the patient's dose was needed.
Patient #8 received an initial dose on June 6, 2012. Documented in patient record #8 was an order by the physician dated June 11, 2012 that included a standing order to increase the patient dosage 5 mg daily for the next two days to 45 mg. There was no documentation that the narcotic treatment physician continued to assess the patient to determine if an increase in the patient's dose was needed.
Patient #13 received an initial dose on January 11, 2012. Documented in patient record #13 was an order by the physician dated January 17, 2012 that included a standing order to increase the patient dosage 5 mg daily for the next two days to 40 mg. There was no documentation that the narcotic treatment physician continued to assess the patient to determine if an increase in the patient's dose was needed.
An interview with the nurse manager took place on July 26, 2012. The findings were not disputed and there was no further documentation provided.
|
Plan of Correction
Under the direction of the clinical administrator or her designee, NATP physicians will be trained by the Medical Director by 9/1/12 on: the requirement to determine the initial and subsequent dose changes of methadone via direct assessment of the patient each time there is a medication dose change; documentation in the patient clinical record that the narcotic treatment physician continued to assess the patient to determine if an increase in the patient's dose was needed; each order must be written, timed and dated by the physician. Clinical nurses will monitor compliance via auditing 10 charts per month for 4 months beginning with the month of September 2012 and ending with the month of December 2012. The results of the monthly chart audits will be shared with the NATP Physicians and program leadership. |