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 15, 2013, through January 16, 2013, by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Kensington Hospital was found not to be in compliance with the applicable chapters of 4 PA Code and 28 PA Code which pertain to the facility. The following deficiencies were identified during this inspection.
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Plan of Correction
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715.9(a)(4) 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:
(4) Have a narcotic treatment physician make a face-to-face determination of whether an individual is currently physiologically dependent upon a narcotic drug and has been physiologically dependent for at least 1 year prior to admission for maintenance treatment. The narcotic treatment physician shall document in the patient 's record the basis for the determination of current dependency and evidence of a 1 year history of addiction.
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Observations
Based on the review of patient records, the narcotic treatment program failed to document a narcotic treatment physician made a face-to-face determination of current dependency in one of five records.
The findings include:
Five patient records were reviewed during the onsite monitoring visit. All records were reviewed for the narcotic treatment physician face-to-face determination of current dependency. The facility failed to document a narcotic treatment physician made a face-to-face determination in patient record # 5.
Patient # 5 was admitted into treatment on January 14, 2013, and received a narcotic agent. The physical exam and the documentation of physical dependency was completed by the Certified Registered Nurse Practitioner (CRNP) on January 14, 2013.
The findings were reviewed with the Project Director, Facility Director and hospital medical director and were not disputed.
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Plan of Correction
The Medical Director of the Addictions Services Department or the physician on call will be responsible for documenting a patient's need for methadone assisted detoxification. The physician will be responsible for assessment and documentation for justifying the patient's need for methadone assisted detox. The Performance Improvement Coordinator will conduct random monthly chart reviews to assure continued compliance.
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715.12(1-5) LICENSURE Informed patient consent
A narcotic treatment program shall obtain an informed, voluntary, written consent before an agent may be administered to the patient for either maintenance or detoxification treatment. The following shall appear on the patient consent form:
(1) That methadone and LAAM are narcotic drugs which can be harmful if taken without medical supervision.
(2) That methadone and LAAM are addictive medications and may, like other drugs used in medical practices, produce adverse results.
(3) That alternative methods of treatment exist.
(4) That the possible risks and complications of treatment have been explained to the patient.
(5) That methadone is transmitted to the unborn child and will cause physical dependence.
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Observations
Based on the review of patient records, the narcotic treatment program failed to obtain an informed, voluntary, written consent prior to the administration of a narcotic agent in two of five records.
The findings include:
Five patient records were reviewed during the onsite monitoring visit. All records were reviewed for the completion of an informed, voluntary, written consent prior to the administration of a narcotic agent. The narcotic treatment program failed to document the completion of an informed, voluntary, written consent prior to the administration of a narcotic agent in records # 1 and 4.
Patient # 1 was admitted into treatment on December 13, 2012. The patient received their initial dose of a narcotic agent on December 13, 2012, at 11:40 a.m. There was no documentation of an informed, voluntary, written consent prior to the administration of a narcotic agent in the record at the time of the review. Patient # 1 was discharged on December 14, 2012.
Patient # 4 was admitted into treatment on January 11, 2013. The patient received their initial dose of a narcotic agent on January 11, 2013 at 9:30 p.m. The documentation of an informed, voluntary written consent included a signature. The documentation was not dated to provide verification the signature was prior to the administration of a narcotic agent. Patient # 4 was discharged on January 16, 2013.
The findings were reviewed with the Project Director, Facility Director and clinical staff and not disputed.
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Plan of Correction
The admitting physician, in most cases the Medical Director of the Detox Unit, will inform the person seeking detox that this facility uses Methadone as the medication for anyone presenting for opiate withdrawal, and will list any side effects that the patient may experience during their detox process. The necessary paperwork will be included in admissions packet for patients presenting for opiate dependency/withdrawal. The Performance Imporvement Coordinator will conduct rendom monthly chart reviews to ensure continued compliance. |
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 and administrative documents, the narcotic treatment program failed to obtain a complete drug screen urinalysis prior to the administration of a narcotic agent in five of five patient records.
The findings include:
Five patient records were reviewed during the onsite monitoring visit. All records were reviewed for a complete drug screen urinalysis prior to the administration of a narcotic agent.
The onsite laboratory permit was reviewed. The permit included providing dipstick urinalysis. The collected specimen is then sent to an offsite laboratory.
The narcotic treatment program did not receive the completed drug-screening urinalysis prior to administration of a narcotic agent in five of five patient records.
Patient # 1 was admitted into treatment on December 13, 2012, and received a narcotic agent at 11:40 a.m. The initial drug-screening specimen was collected on December 13, 2012, at 12 p.m. The patient was discharged on December 14, 2013.
Patient # 2 was admitted into treatment on November 24, 2012, and received a narcotic agent at 6 p.m. The initial drug-screening specimen was collected on November 25, 2012, at 7 p.m. The patient was discharged on November 29, 2012.
Patient # 3 was admitted into treatment on January 14, 2013, and received a narcotic agent at 11 p.m. The initial drug-screening specimen was collected on January 14, 2013, at 6 p.m. The report date of the initial drug-screening urinalysis was January 15, 2013, at 1:05 p.m. and was reviewed by the narcotic treatment physician on January 16, 2013.
Patient # 4 was admitted into treatment on January 11, 2013, and received a narcotic agent at 9:30 p.m. The initial drug-screening urinalysis was collected on January 12, 2013. The report was reviewed by the narcotic treatment physician on January 16, 2013. The patient was discharged on January 16, 2013.
Patient # 5 was admitted into treatment on January 14, 2013, and received a narcotic agent at 2:30 p.m. The initial drug-screening urinalysis result was not documented in the record at the time of the review.
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Plan of Correction
When a person presents at our Admission Office, we complete the standard protocol of admission to detox with a Urine Drug Screen to confirm the presence of drugs reported by the patient. A UDS is completed to confirm the need for detox from opiates. This sample is then tested by the main lab to confirm the initial UDS report. No one will be medicated with a narcotic until the UDS confirms the presence of opiates in the person's system. This change will be monitored by the physician treating and prescribing for the patient admitted to detox. This process was started by the Clinical Director at a meeting on 2-5-13. |
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
Based on the review of patient records, the narcotic treatment program failed to document the consultation between the narcotic treatment physician determining the initial dose and the physician performing the physical examination in one of five records.
The findings include:
Five patient records were reviewed during the onsite monitoring visit. All records were reviewed for the narcotic treatment physician physical exam and initial dose. The facility failed to document a narcotic treatment physician consultation with the physician completing the physical examination in patient record # 5.
Patient # 5 was admitted into treatment on January 14, 2013, and received a narcotic agent. The physical exam, diagnosis and the documentation of physical dependency was completed by the Certified Registered Nurse Practitioner (CRNP) on January 14, 2013. The physical exam was not signed by the narcotic treatment physician. A consultation with the CRNP was not documented by the narcotic treatment physician prior to documenting an order for the initial dose. A consultation was not documented as of the date of the review.
The findings were reviewed with the Project Director, Facility Director and hospital medical director and were not disputed.
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Plan of Correction
Any prescribing physician involved in starting a patient in Methadone detox for opiate dependency/withdrawal shall consult with the Director of Addictions Services before starting the induction process with Methadone. The Director will then consider all contrituting factors in determining the starting dose of medication. This process was begun subsequent to a staff meeting on 2-5-13. All medication consults will be facilitated with the Addictions Unit Medical Director who will authorize a dose of Methadone used in a patient's detox process, The Medical Director of Addictions Services will monitor the compliance with this change in detox process.
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