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 January 27, 28 and 29, 2009 by staff from the Division of of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Alliance Medical Services 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 February 27, 2009.
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Plan of Correction
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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
Based on a review of patient records, the facility failed to document a review of the patient dosage level at least twice a year in one of two patient records.
The findings include:
Fifteen patient records were reviewed on January 29, 2009. A review of the patient dosage level at least twice a year was required in two of the patient records. The facility did not document a second dosage review in patient record #8.
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Plan of Correction
The Medical Director will note all dose reviews on the 6-Month Review form. The review done at the annual physical appointment will be documented o the review form rather than the annual physical form. |
715.16(a)(5) LICENSURE Take-home privileges
(a) A narcotic treatment program shall determine whether a patient may be provided take-home medications.
(5) A narcotic treatment program shall develop written policies and procedures relating to granting and rescinding take-home medication privileges.
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Observations
Based on a review of the facility's policy and procedures, the facility failed to develop procedures for rescinding take home privileges when a patient no longer meets the eight point criteria.
The findings include:
The facility's policy and procedure manual was reviewed on January 27, 2009. The procedure for rescinding take home privileges only addressed positive urine screens, and failed to address the other seven points of the eight point criteria. In addition, the procedure did not include the process or procedure relating to how the privileges would be revoked.
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Plan of Correction
The Project Director, Facility Director, and the Clinical Committee will update the policy and procedure manual to include all eight points of the Take-Home Criteria. Furthermore, the policy will be updated to include the process related to the revocation of take-home privileges. |
715.17(c)(1)(i-vi)) LICENSURE Medication control
(c) A narcotic treatment program shall develop and implement written policies and procedures regarding the medications used by patients which shall include, at a minimum:
(1) Administration of medication.
(i) A narcotic treatment physician shall determine the patient 's initial and subsequent dose and schedule. The physician shall communicate the initial and subsequent dose and schedule to the person responsible for the administration of medication. Each medication order and dosage change shall be written and signed by the narcotic treatment physician.
(ii) An agent shall be administered or dispensed only by a practitioner licensed under the appropriate Federal and State laws to dispense agents to patients.
(iii) Only authorized staff and patients who are receiving medication shall be permitted in the dispensing area.
(iv) There shall be only one patient permitted at a dispensing station at any given time.
(v) Each patient shall be observed when ingesting the agent.
(vi) Administering and dispensing shall be conducted in a manner that protects the patient from disruption or annoyance from other individuals.
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Observations
Based on a review of patient records, the facility physician failed to document a new medication order for patient dosing schedule changes in the patient dosing schedule following a change in the patient's take home status in three of three patient records.
The findings include:
Fifteen patient records were reviewed on January 29, 2009. A new medication order for changes in the patient dosing schedule was required in three of three patient records. The facility physician did not document a new medication order reflecting the changes in the patient dosing schedule in patient records #6, 7 and 8. Documentation in the patient records indicated a change in take home privileges but there were no written orders to identify these changes.
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Plan of Correction
The Take-Home Request form, which was updated by the Facility Director on 2/2/09 to clearly identify the physician as being the person ordering any take-home changes, will serve as the Doctor's Order for any changes in take-home priviliges. This form will be filed by the Medical Director in the medical chart in the section for dose change orders. |