Observations
The facility failed to document that a physician assistant may perform functions of a narcotic treatment physician in a narcotic treatment program if the records are properly countersigned by the medical director or a narcotic treatment physician.Eleven patient records were reviewed on April 5-7, 2017. Patient records #4, 6 and 8 included physical examinations performed by the physician's assistant and required the narcotic treatment physician's countersignature, within three days, as per the state licensing body. Patient #4 was admitted on 9/15/16 and the physician assistant performed a physical on 9/15/16. A physician countersignature was due by 9/18/16. There was no physician countersignature present.Patient #6 was admitted on 9/29/16 and discharged on 3/9/17 the physician assistant performed a physical on 9/29/16. A physician countersignature was due by 10/2/16. There was no physician countersignature present.Patient #8 was admitted on 10/12/15 and the physician assistant performed an annual physical on 10/20/16. A physician countersignature was due by 10/23/16. There was no physician countersignature present.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
At the time of admission for Patients #4,6, and 8, our SMART computer system, which was new at the time, did not generate a countersignature option for certain Physician Assistant services. This was corrected in October, 2016. Now all Physician Assistant notes and documents automatically generate and prompt a countersignature from the MD. This is monitored by nursing staff and Facility Director to ensure that MD is countersigning within three days. |