INITIAL COMMENTS
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This report is a result of an onsite licensure renewal and methadone monitoring inspection. The inspection was conducted on January 26-27, 2016 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the onsite inspection, Discovery House - Duncansville 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 the inspection:
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Plan of Correction
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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
Based on a review of patient records, the facility failed to notify the patient, in writing, of a decision to involuntarily terminate the patient's treatment at the project, in one of one patient records.
The findings include:
Eleven patient records were reviewed on January 26-27, 2016. Four of the patient records reviewed were discharged patients. One of the discharged patients was involuntarily terminated from treatment at the project. The facility failed to notify the patient, in writing, of a decision to involuntarily terminate the patient's treatment at the project, in patient record # 6.
Patient #6 was admitted into treatment on January 28, 2015 and was involuntarily terminated from the project on September 15, 2015. There was no documentation of written notification provided to the patient as of the on-site inspection which was conducted on January 26-27, 2016.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
709.33(a) LICENSURE
Notification of Termination
A meeting was held on 02/04/2106 for all staff to review the policy of administrative withdrawals. We reviewed the steps that need to be followed and the form that needs to be completed. Every patient that is given an involuntary discharge will be given written documentation of the discharge. The clinic director will be responsible for ensuring that the proper procedure is followed when a patient is administratively discharged. |
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 review of the patient records, the facility failed to obtain a complete drug screen urinalysis prior to the administration of buprenorphine, a narcotic agent, and at least monthly thereafter. A complete drug screen includes receiving the results from the CLIA and Department of Health approved laboratory.
The findings include:
Four buprenorphine patient records were reviewed on January 26 - 27, 2016. All patients are required to complete a drug screen urinalysis prior to the administration of buprenorphine, a narcotic agent, and at least monthly thereafter. A complete urine drug screen includes receiving the results from the CLIA and Department of Health approved laboratory. The facility failed to obtain a complete drug screen urinalysis prior to the administration of buprenorphine, a narcotic agent, and monthly thereafter in records # 3, 4, 5 and 6.
Patient #3 was admitted on April 29, 2015. Patient #3 received their first dose of buprenorphine on May 5, 2015. The initial and monthly urine screens have been completed by the facility; however, none of the urine samples, including the initial were sent out to a laboratory for urinalysis.
Patient #4 was admitted on June 25, 2015. Patient #4 received their first dose of buprenorphine on July 7, 2015. The initial and monthly urine screens have been completed by the facility; however, none of the urine samples, including the initial were sent out to a laboratory for urinalysis.
Patient #5 was admitted on February 4, 2015. Patient #5 received their first dose of buprenorphine on February 10, 2015. The initial and monthly urine screens have been completed by the facility; however, none of the urine samples, including the initial were sent out to a laboratory for urinalysis.
Patient #6 was admitted on January 28, 2015. Patient #6 received their first dose of buprenorphine on February 3, 2015. The initial and monthly urine screens have been completed by the facility; however, none of the urine samples, including the initial were sent out to a laboratory for urinalysis.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
715.14(a) LICENSURE
Urine testing:
On 01/28/2016 we began to send all urine analysis screens out to a laboratory for testing. We are currently utilizing clinical science for this. A patient will not receive medication prior to the results of the urinalysis screen coming back from the lab. The LPN in our program will be responsible for ensuring that all urine analysis screens are sent out for testing. |
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 a review of patient records, the facility's physician failed to adhere to the dosing protocol listed on the medication by ordering that single dose Suboxone film be halved and/or quartered in two of four patient records. The medication packaging identifies this as a single dose medication.
The findings include:
On September 1, 2015, the physician prescribed Suboxone 8 mg/2 mg SL film, 1/2 film QAM (morning) and 1/4 film QPM (evening) daily for patient #5.
On February 3, February 12, February 19, February 26, March 12, June 12, June 25, July 23, August 6, August 20, August 27, and September 10, 2015, the physician prescribed Suboxone 8 mg/2 mg SL film, 1/2 film BID (twice daily). On March 26, April 2, April 16, April 30, May 14 and May 28, 2015, the physician prescribed Suboxone 8mg/2 mg SL film, 1/2 film tid (three times daily) for patient #6.
Suboxone film is not formulated to be cut into smaller doses. Prescriptions need to be for the manufactured quantities of 12 mg/3 mg, 8 mg/2 mg, 4 mg/1 mg or 2 mg/.5 mg doses.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
715.15(b) LICENSURE
Medication dosage
I will hold a meeting with the prescribing physician on 2/9/2016. We will review the prescribing of medication the way that it is intended. We will ensure that he only prescribes Suboxone film in the manufactured quantities of 12 mg/3 mg, 8 mg/2 mg, 4 mg/1 mg or 2 mg/.5 mg doses. The prescribing physician will be responsible for monitoring this.
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