INITIAL COMMENTS
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This report is a result of an on-site inspection conducted for the approval to use a narcotic agent, specifically methadone, in the treatment of narcotic addiction. This inspection was conducted on February 1-4, 2010 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Esper Treatment Center, Inc. was found not to be compliance with the applicable chapters of 28 PA Code which pertain to the facility. Deficiencies were identified during this inspection and a plan of correction is due on March 1, 2010.
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Plan of Correction
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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 the review of patient records, an interview with the facility director and clinical supervisor, the facility failed to ensure at least monthly random urine drug screens in three of seventeen patient records.
The findings include:
Seventeen patient records were reviewed on February 1-4, 2010. The facility director and clinical supervisor were interviewed on February 4, 2010. Thirteen patient records were reviewed for monthly urine drug screen results.
Patient record # 7 was missing a urine drug screen for January 2010.
Patient record # 8 was missing a urine drug screen for January 2010.
Patient record # 17 was missing a urine drug screen for January 2010.
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Plan of Correction
The Clinical Director will schedule all random urines on the computer system. The computer will generate the randon list to ensure all urines are pulled in a timely manner. The Clinical Director will check weekly as to the status of pulled urines and pending pulled urines to ensure that all urines are scheduled and pulled. |
715.16(b)(1-8) LICENSURE Take-home privileges
(b) The narcotic treatment physician shall consider the following in determining whether, in exercising reasonable clinical judgment, a patient is responsible in handling narcotic drugs:
(1) Absence of recent abuse of drugs (narcotic or non-narcotic), including alcohol.
(2) Regular narcotic treatment program attendance.
(3) Absence of serious behavioral problems at the narcotic treatment program.
(4) Absence of known recent criminal activity.
(5) Stability of the patient 's home environment and social relationships.
(6) Length of time in comprehensive maintenance treatment.
(7) Assurance that take-home medication can be safely stored within the patient 's home.
(8) Whether the rehabilitative benefit to the patient derived from decreasing the frequency of attendance outweighs the potential risks of drug diversion.
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Observations
Based on the review of patient records and interviews with facility staff, the facility failed to document that the narcotic treatment physician considered 715.16 (b)(1-8) in determining whether, in exercising reasonable clinical judgment, a patient is responsible in handling narcotic drugs in one patient of three patient records.
The findings included:
Seventeen patient records were reviewed on February 1-4, 2010. Three patient records were reviewed for take home privileges. The facility did not document that the narcotic treatment physician considered 715.16(b)(1-8) in determining take home privileges in patient record # 2.
Patient # 2, admitted on September 4, 2004, had his take home privileges rescinded on July 29, 2009 due to not returning take home bottles. The patient reported that he had lost the take home bottles. Documentation in the patient record indicated that the patient stated that the bottles may have fallen out of his motorcycle bag. As the patient had not shown responsibility in handling the narcotic drug, the take home privileges were rescinded. The patient's take home status was reinstated and he was granted bi weekly take homes on September 9, 2009 and then 6 day take homes on September 29, 2009. The narcotic treatment physician did not document in either order that he had considered the 715.16 (b)(1-8) criteria prior to reinstating the take home privileges for this patient. There was no documentation provided that showed the patient had made necessary changes to ensure he was once again responsible for the handling of narcotic drugs.
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Plan of Correction
When a patient is eligible for take homes all the criteria must be met. It is incumbent on the counselor to document that all the criteria have been met before take homes are an option for the patient. It will be documented by the counselor that they have complied and after all the documentation has been completed it will then go to the physician for approval or denial of the take homes. Take home status will be discussed at the weekly peer review meeting at which time the Clinical Director will ask if the patient has met all the criteria and if it is documented. The teams recommendations will be presented to the physician along with all necessary documentation. It is the decision of the physician if he grants take homes or not. |
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
Based on a review of patient records, the facility failed to provide each patient with the minimal requirement of an average of 2.5 hours of psychotherapy per month during the patient's first 2 years of treatment in one of six patient records.
The findings include:
Seventeen patient records were reviewed on February 1-4, 2010. Six patient records were reviewed for compliance of providing the patient with an average of 2.5 hours of psychotherapy per month during the patient 's first 2 years. The facility did not document that the patient received an average of 2.5 hours of psychotherapy per month during the patient 's first 2 years in patient # 8.
Patient # 8 was admitted on December 8, 2009. Documentation showed that the patient had received a total of 1 hour of counseling for the month December, 2009 and 2.50 hours of counseling for the month of January 2010, averaging 1.67 hours per month.
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Plan of Correction
The Clinical Director will review with all counselors the state regulations regarding state mandatory counseling hours for all patients. This regualtion will be read and discussed with all clinical staff at the weekly clinical peer review meeting on 2/18/2010. All counselors will sign off stating that they will adhere toand understand the regulation. To ensure compliance the Clinical Director will review hours to ensure compliance. |