Chandler, AZ’s Archstone Care Center has been cited for the following violations in the 2019 DHHS / CMS report.
Failure to honor the resident’s right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. (F 0578)
Improper record-keeping led to inconsistencies regarding an Advance Directive (AD) order in one patient’s record.
The initial Advance Directive Decision order revealed a Do Not Resuscitate (DNR) and Do Not Hospitalize (DNH) order, however this form was not completed by a physician per law. But other medical records showed that he did not want a DNR/DNH.
Failure to assess the resident when there is a significant change in condition. (F 0637)
The facility failed to ensure that a significant change in status Minimum Data Set (MDS), a standardized assessment tool, was completed within the required timeframe for one resident. In this case, a resident was admitted to a hospice, however this was not updated as required in the MDS assessment.
The MDS assessment policy instructs a Significant Change in Status Assessment (SCSA) is required to be performed when a terminally ill resident enrolls in a hospice program within 14 days from the effective date of the hospice election.
Failure to provide safe and appropriate respiratory care for a resident when needed. (F 0695)
The facility failed to ensure that oxygen was administered per physician’s order for one resident. The orders were to give oxygen at 2 liters per minute (LPM), but it was instead set at 3.5 LPM.
Failure to ensure each resident’s drug regimen is free from unnecessary drugs. (F 0757)
Facility failed to ensure that pain medication was administered per the physician’s orders. tHe orders were to administer 10mg of HCl every 4 hours for pain 9-10, but it was administered for a pain level of 2 at less frequent intervals. The expectation and policy is to follow a standardized approach per physician’s orders.
Failure to ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. (F 0761)
Several different types of expired medications were made available to two residents, and administered to one resident. This happened regardless of the fact that the facilities Sorage of Medications policy clarifies that outdieated medications or those improperly stored are to be disposed of.
How common are medication errors in nursing homes?
Several of the violations above are to do with the way the facility manages and administers medication.
52 US nursing homes resulted in a medication error rate of 12.2%, and suggests that some 16-27% of nursing home residents regularly experience medication errors.
Examples of medication errors include:
- Giving expired medication
- Omission of dosage
- Giving the wrong strength of medication
- Overdose or underdose
- Wrong medication
The above violations did not result in harm. Expired medications typically lose their potency however nursing homes have stringent rules for the handling, storage and disposal of medications in order to prevent misuse by any party. There is a small chance, however, that expired medications could present a danger — for instance, if they are being administered but no longer effective.
If a medication error results in harm, it could constitute neglect or abuse. The most likely cause for harm in this context is giving the incorrect dosage of medication.
About Advance Directives (AD) in Nursing Homes
Advance Directives are essentially instructions from a living patient which communicate their preferences if they are no longer able to make a decision regarding end of life issues. The CDC states that the most common types of ADs are living wills and DNR orders.
There are very specific rules about prehospital medical care directives per 36-3251 of the Arizona Revised Statutes to ensure accuracy. The above violation did not result in harm, but it’s vital that residents and their caretakers are clear on these issues in order to protect themselves.
If you have questions or concerns about a legal issue in an Arizona nursing home, reach out today for a free consultation — we’ll be happy to help.