INITIAL COMMENTS
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This report is a result of an on-site inspection for the approval to use a narcotic agent, specifically methadone, in the treatment of narcotic addiction. This inspection was conducted on July 17, 18, and 19, 2007 by staff of the Division of Drug and Alcohol Program Licensure. Deficiencies were identified and plans of correction are due on August 9, 2007. .
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Plan of Correction
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715.9(a)(2) LICENSURE Intake
(a) Prior to administration of an agent, a narcotic treatment program shall screen each individual to determine eligibility for admission. The narcotic treatment program shall:
(2) Verify the individual 's identity, including name, address, date of birth, emergency contact and other identifying data.
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Observations
The facility failed to provide documentation that verification of patient identity was reviewed and documented prior to dose induction for patient #1. Specifically, a copy of photo identification was not included in patient chart.
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Plan of Correction
Effective immediately, all patients are required to provide verification of identity at admission with a driver's license, or other photo identification and a copy will be maintained in the chart. |
715.15(a) LICENSURE Medication Dosage
(a) The narcotic treatment physician shall review the dosage levels at least twice a year, with each review occurring at least 2 months apart, to determine a patient 's therapeutic dosage.
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Observations
The facility failed to provide documentation that the physician performed biannual therapeutic dose reviews for patients #5, 6, 7,8,10, and 11.
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Plan of Correction
Effective immediately: Schedule for biannual dose evaluations have been developed. The date for the biannual dose evaluation is set 6 months after admission. The next biannual dose evaluation will occur in conjunction with the annual physical.
A form has been developed to document completion of biannual dose evaluation. Documentation for the last 6 month dose evaluation will be found on the annual physical review.
Computer and manual scheduling procedures are being set up to assure compliance with the biannual dose evaluation regulation.
Nursing Supervisor will monitor for compliance. |
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
The facility failed to document a consultation between prescribing physician and physician assistant who conducted the physical examination in chart # 9 prior to the patient's initial dose.
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Plan of Correction
During the DAPL survey in November 2006, Lebanon Treatment Center was cited for failure to document consultation between prescribing physician and physician assistant in a patient chart. As a plan of action in response to that citation, the "History and Physical" form was revised to include documentation of consult between physician assistant and prescribing physician. Upon completing the history and physical, the physician's assistant contacts the prescribing physician via phone. The findings are reported and the physician assistant documents this contact. There is a separate area for the prescribing physician's findings and signature.
This revised form was introduced shortly after the admission of the patient whose chart was cited. The h and p form continues to provide documentation of consultations between the physician assistants and the prescribing physician.
Nursing Supervisor will continue to monitor for compliance. |
715.19(1) LICENSURE Psychotherapy services
A narcotic treatment program shall provide individualized psychotherapy services and shall meet the following requirements:
(1) A narcotic treatment program shall provide each patient an average of 2.5 hours of psychotherapy per month during the patient 's first 2 years, 1 hour of which shall be individual psychotherapy. Additional psychotherapy shall be provided as dictated by ongoing assessment of the patient.
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Observations
The facility failed to provide the minimum requirement of 2.5 hours of psychotherapy per month for patients # 4, 5, 8, and 13.
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Plan of Correction
The requirements of treatment will be reviewed with staff particularly regarding the expectations of counseling hours. This will be addressed via the next weekly group clinical supervision.
The minimum 2.5 hour requirement will be reviewed along with the expectation of individualized treatment with clinical time individually and clinically based. |
715.23(b)(5) LICENSURE Patient records
(b) Each patient file shall include the following information:
(5) The results of all annual physical examinations given by the narcotic treatment program which includes an annual reevaluation by the narcotic treatment physician.
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Observations
The facility failed to document that annual physical evaluations were completed. Specifically, in chart # 2, the physician signed and dated a blank physical examination form prior to the completion of the examination.
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Plan of Correction
Effective immediately:
The noncompliance was immediately reviewed with physician. The inappropriateness of this practice was emphasized. It was explained that documents are not to be signed or dated until completion.
To facilitate this practice, patient charts will not be available to physician until the patient arrives for the scheduled appointment.
Nursing supervisor will monitor for compliance. |
715.23(b)(23) LICENSURE Patient records
(b) Each patient file shall include the following information:
(23) Discharge summary.
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Observations
The facility failed to provide detailed summaries for patient discharges in charts #17, 18, and 19, specifically the discharge summaries failed to include the reason for the patient seeking treatment, the patient's response to treatment and status on discharge.
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Plan of Correction
At the next weekly group clinical supervision meeting, a review will occur of the necessary information to be included in the discharge summary. Discharge summaries will be reviewed for the next 6 months by the clinical supervisor for appropriate documentation of reason the patient saught treatment, response to treatment, and status upon discharge. |
715.23(d)(2) LICENSURE Patient records
(d) A narcotic treatment program shall prepare a treatment plan that outlines realistic short and long-term treatment goals which are mutually acceptable to the patient and the narcotic treatment program.
(2) The narcotic treatment physician or the patient 's counselor shall review, reevaluate, modify and update each patient 's treatment plan as required by Chapters 157, 709 and 711 (relating to drug and alcohol services general provisions; standards for licensure of freestanding treatment activities; and standards for certification of treatment activities which are a part of a health care facility).
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Observations
The facility failed to review and update the comprehensive treatment goals and plans to reflect patient progress or lack of for patients # 2, 5, 6, 8, 11, and 12.
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Plan of Correction
At the next weekly clinical group supervision meeting, the procedure, timeline, and expectations for update of the comprehensive goals and plans will be reviewed.
Particularly, the expectation of identifying progress for the individual patient.
The clinical supervisor currently reviews comprehensive and update treatment plans. This will continue, and charts will be randomly audited by the clinical supervisor for compliance with this regulation. If further issues arise, a corrective action plan will be completed for individual clinicians. |