Observations
Based on the review of administrative documentation, the facility failed to provide at least one hour of physician time a week, on site for, every ten patients for one of the three weeks reviewed.
The findings include:
Physician and physician extender time sheets for the months of May 2013, June 2013, July 2013, and August 2013 were reviewed on August 12, 2013. Three weeks were chosen and reviewed in relation to the patient census for those three weeks. Two weeks provided sufficient onsite physician hours for the patient census. One week provided insufficient onsite physician hours.
During the week of June 17-21, 2013, the patient census was 476. The facility was required to provide at least 47.6 physician hours. There were 33 physician and physician extender hours documented.
The findings were reviewed with the director and were not disputed.
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Plan of Correction
A new full time Physican's Assistant was hired on August 2, 2013. Her hours will cover the necessary hours per week to meet the regulation in conjunction with the Medical Director's weekly hours. In the future, other physician extenders within the Pinnacle system will be used, if needed,to cover potential lapses in coverage. |
Observations
Based on a review of patient records, the facility failed to ensure that the narcotic treatment physician is determining the proper dosage level for a patient in five of sixteen patient records.
The findings include:
Sixteen patient records were reviewed on August 13-14, 2013. All patient records were reviewed for medication order and dosage change which shall be written and signed by the narcotic treatment physician. Patient records # 6, 10, 11,12, and 16 contained documentation of medication orders that were completed by someone other than the narcotic treatment physician.
Patient #6 was admitted to treatment on March 20, 2013. A medication order was completed on 8-8-2013 by someone other than the narcotic treatment physician.
Patient #10 was admitted to treatment on June 24, 2013. A medication order was completed on 8-8-2013 by someone other than the narcotic treatment physician.
Patient #11 was admitted to treatment on November 13, 2012, and was discharged on March 17, 2013. Medication orders for a detoxification were completed on March 14, 2013, March 15, 2013, March 16, 2013, March 17, 2013, March 18, 2013, March 19, 2013, and March 20, 2013, by someone other than the narcotic treatment physician, and these medication orders were not signed by the physician.
Patient #12 was admitted to treatment on November 14, 2012, and was discharged on June 3, 2013. Medication orders for a detoxification were completed on May 29, 2013, May 30, 2013, May 31, 2013, June 1, 2013, June 2, 2013, June 3, 2013, and June 4, 2013, by someone other than the narcotic treatment physician.
Patient #16 was admitted to treatment on May 14, 2013. A medication order was completed on 8-9-2013 by someone other than the narcotic treatment physician.
The findings were reviewed with the director and were not disputed.
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Plan of Correction
The Medical Director, Physician's Assistant, and Dispensing Nurses participated in a training meeting on 8/20/13 to review the regulations for dose orders and verbal orders. The Nursing Supervisor and Facility Director will review 20 charts per month to ensure that verbal orders and dose orders are being recorded according to regulation. |