An Iowa nursing home was cited recently by state inspectors for 16 regulatory violations, including a failure to address the illegal drug use of a male resident who had a psychoactive substance abuse disorder (SUD). Based on observation, clinical record review, staff and resident interviews, and facility policy review the inspectors found that the facility failed to provide the necessary assessments for the resident. A determination was made that the facility’s noncompliance placed the residents in the facility in immediate jeopardy.
In mid-September, the nursing home had received a lab report that indicated the man had tested positive for methamphetamine. Days later, he was observed screaming at the staff, upset over a television that he claimed was his but which belonged to the facility. He threatened to start breaking things and then went into another resident’s room and disconnected that resident’s oxygen supply.
According to the state inspection report, days after that incident, a nurse reported that the police had been called to the facility several times in the previous week, but they could not do anything because the resident refused to let anyone search through his belongings. Then a nurse walked into the resident’s room while he was smoking from a meth pipe. The police returned to the facility and searched his room. They found three meth pipes and white residue in a bag which later tested positive for methamphetamine.
Nine days later, a state inspector interviewed the resident, and he confirmed that staff had caught him smoking methamphetamine in his room. A week after that interview, a worker approached a nurse and reported that the resident’s room smelled bad. The nurse reported later that she could smell the methamphetamine even before entering the resident’s room.
On November 2, the nursing home tried to discharge the resident to his home, but they did not have an effective plan to ensure a safe transition. The facility’s interim director of nursing told an inspector that the resident had to be discharged that day because another resident was threatening to call the local television station and report that the facility was housing a drug user.
A Minimum Data Set (MDS) assessment form documented the resident with diagnoses that included psychoactive substance abuse, bipolar, depression, deep vein thrombosis, hypertension, and a hip fracture. The resident’s care plan failed to address his illegal drug use. The resident’s record lacked documentation of staff assessment and/or intervention according to the circumstance.
As a result of the inspector’s findings, the Iowa Department of Inspections and Appeals determined residents of the home had been placed in immediate jeopardy due to insufficient competent staff and a failure to adequately assess residents’ needs. Two state fines totaling $15,000 were proposed but held in suspension so that the Centers for Medicare & Medicaid Services (CMS) can consider taking action in the matter.
Compliance Perspective
Issue
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents’ choices. If there is a history of SUD, the resident’s comprehensive care plan should contain interventions, if appropriate, to prevent substance use in the facility as well as interventions for when substance use is suspected or identified. Facility staff should implement care plan interventions which should include increased monitoring and supervision of the resident, increased supervision of visitors, and notification of the resident’s physician or non-physician practitioner. For example, a resident displays changes in behavior or unexplained lethargy after his or her visitors leave or other residents report observing the use of substances. When substance use is suspected (in the facility or upon return from an absence from the facility), which could lead to overdose, facility staff should immediately implement the care plan interventions.
Discussion Points
- Review your policies and procedures on SUD, quality of care, and care plan interventions. Update as needed.
- Provide staff education on SUD, including how to recognize the signs and symptoms of substance abuse and to report their concerns to their supervisor. Each nurse should know it is his/her responsibility to complete an assessment and notify the doctor, family, and DON/ Administrator if signs and symptoms exist. Ensure staff know what to do when residents with SUD threaten or lash out, and that it is OK to call the police when behaviors escalate beyond those that staff can safely handle. Offer the person with an SUD supportive education and access to appropriate medical care and support groups. Place training documentation in each employee’s education file, and record patient/ resident education in his or her medical record.
- Periodically audit to ensure residents with SUD are receiving appropriate interventions and monitoring and that staff know to report any concerns to their supervisor, the compliance officer, or via the anonymous hotline.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
