Sunday, September 30, 2018

Anti-Psychotic Drug Use Plummets in TN Homes


By Walter F. Roche Jr.

The use of potentially deadly anti-psychotic medications on long term Tennessee nursing home patients suffering from dementia has plummeted since 2012, the result of the combined efforts of the state and private partners.
Data provided Friday by the U.S. Centers for Medicare and Medicaid Services shows the percentage of long-stay Tennessee nursing home patients diagnosed with dementia and being treated with anti-psychotics dropped to 15.1 percent in the first quarter of 2018. That represents a 49.5 percent drop from the the 30 percent rate recorded in 2012, when CMS began assembling quarterly statistics.
And while Tennessee ranked 49th among other states in 2012, the latest data show it ranks 30th.
The effort to reduce the use of anti-psychotics on dementia patients is based on the fact that the drugs can be deadly for these patients.
In fact the drugs are required to carry a so-called black box label warning users of the potential deadly result for dementia patients. Among the drugs requiring the black box label are risperidone, haloperidol and perphenazine.

WARNING: Increased mortality in elderly patients with dementia related psychoses


The new data is being hailed by Tennessee Health Commissioner John Dreyzehner who called the achievement an "important milestone."
State health officials credit efforts by the nursing homes themselves along with QSource, the Eden Alternative and Vanderbilt University for educational efforts that included regional conferences along with webinars.
The seminars included a 2014 session in Nashville where nursing home employees from the region were told about alternative methods for the treatment of dementia patients, such as re-direction.
"The evidence is that the use of these drugs actually shortens peoples lives," Bill Thomas of the non-profit Eden Alternative said at the May 2014 session.
The CMS data show Hawaii was ranked first in the latest data with only 6.2 percent use of anti-psychotic on dementia patients.
Oklahoma had the worst rate with 19.4 percent use of anti-psychotics on long-term nursing home dementia patients. Not far behind was Alabama where a 19.2 percent rate was reported.
"Working together we've improved the quality of life for more than 3,500 elderly Tennesseans," said Beth Hercher of QSource, a private agency that monitors health care quality.
Contact: wfrochejr999@gmail.com

Saturday, September 29, 2018

PA Vets Home Cited Again


By Walter F. Roche Jr.

A state run nursing home for veterans in Pittsburgh has been cited yet again by Pennsylvania Health Department surveyors for providing poor care to patients.
In a recently released 19-page report state inspectors found that one patient who had fallen and cracked a rib complained of pain but didn't get an X-ray of the rib cage until five days after the initial June 17 incident.
The 236-bed Southwestern Veterans Center was cited not only for the delay in care but also for failing to report the incident as required under state law and regulation.
In fact the report states there were two other incidents, both involving delayed wound care, in which officials at the facility failed to report as required.
The report based on an August on-site visit came just a month after the same facility was cited for negligence when a paraplegic patient was left sitting on a bed pan for two days.
The latest report was based on an annual inspection to determine if the facility still qualified for the federally funded Medicare and Medicaid programs.
The patient with the rib injury fell from a wheelchair on June 17. Although X-rays were taken of his knee and hip, the X-ray of his ribs did not happen until June 22 after he had reported continued pain and was refusing to eat. The X-ray showed a rib fracture and a partially collapsed lung.
The other incidents that went unreported included a patient with a persistent cough and a wound that went untreated.
According to the report the patient had a temperature of 102.3 and had vomited, yet no report was filed.
A third incident involved a patient who had behavioral incidents after falling out of his bed. The report states the facility failed to report a significant change in a patient's condition.
The two patients, the report states, had to endure extended waits, one of up to 56 days, before having their wounds properly assessed.
Still other findings included failure to maintain sanitary conditions in the main dish washing area and failure to properly label drugs.
The home filed a plan of correction in which they promised to change policies and procedures to assure there would be no recurrences.
Officials of the state Department of Military and Veterans Affairs, which runs the state veterans homes did not immediately respond to requests for comment.
Contact:wfrochejr999@gmail.com






Monday, September 24, 2018

Harrisburg Hospital Cited for Lack of Coverage


By Walter F. Roche Jr.

A Harrisburg hospital has been cited for failure to have physicians available when five patients needed emergency resuscitation earlier this year.
In a report made public last week the Select Specialty Hospital at 111 S. Front St. was cited by the state Health Department for failure to have a physician available between late May and mid-July.
In the most recent case a patient was found unresponsive on July 15. Records reviewed by state Health Department surveyors show the patient was administered a series of medication, including epinephrine, as part of the resuscitation effort. But, the report states, there was no evidence a physician had authenticated the orders, a requirement under state regulations.
Four nearly identical cases were cited in the report.
The facility, the report dated Aug. 3 states, "failed to ensure medical services were available for patients in need of emergency services."
The report notes that the hospital was licensed to provide Level IV emergency services. A facility licensed at that level must have a physician available or on call at all times, according to the report.
Staffers questioned during the Aug. 2 site visit told state inspectors that the hospital's contract for those services changed in October of 2017. Prior to that physicians were called on all codes.
A plan of correction filed by the hospital stated that the situation was corrected in early August to ensure that there would be immediate physician coverage for all codes
Requests for comment from the hospital or its parent company, Select Medical, went unanswered.
Contact: wfrochejr999@gmail.com

Thursday, September 13, 2018

Maryville Nursing Home Cited, Fined


By Walter F. Roche Jr

The Tennessee Health Department has ordered an admissions freeze and imposed fines totaling $45,000 on a 181-bed Maryville nursing home after state inspectors found that seven patients at the facility fell nearly 40 times resulting in serious injuries including broken bones and a subdural hematoma.
Commissioner John Dreyzehner said the freeze on admissions was issued against Asbury Place. In addition to the fines and freeze on new admissions he appointed a special monitor to oversee operation of the facility.
The repeated falls by patients at the facility along with numerous other deficiencies were detailed in a 106-page inspection report based on a visit to the nursing home in August.
According to the inspection report seven residents fell a combined total of 39 times with most of those fall occurring in the lastseven months. Nine serious injuries were reported including a subdural hematoma and brokem hips and legs.
The report concludes that the seven were placed in an environment "detrimental to their, health safety and welfare."
One patient, the report states, fell nine times between July of 2017 and July of 2018. Two of those falls resulted in traumatic injury, including a broken hip.
"We are working closely with state and federal health regulatory agencies to ensure full compliance with quality of care guidelines. We are addressing all of the opportunities identified for us in our health care center, and are actively reviewing, and where necessary, strengthening our policies and procedures to make improvements for those we serve," said Cathy Canning, spokeswoman for Asbury.
The report faults the facility for failing to fully investigate the falls, failing to develop care plans to prevent future falls and failing to implement care plans in those cases where a plan was actually provided.
The plans themselves, the state surveyors found, often did not actually address the patient's needs.
When the surveyors questioned staffers about the falls and the failure to address them, they were told,"It is simply an unavoidable risk."
Another told surveyors, "You can't really prevent falls."
"We have a few frequent fallers," another employee told the state surveyors..
A patient who fell in a bathroom at the home on Aug. 2 suffered an acute sub-dural hematoma.
The surveyors concluded that the care plan developed for another patient who suffered four falls was "inappropriate."
A male patient, who fell four times between January and July, suffered a fracture of a cervical bone and required stitches as a result of the last fall.
In some cases the surveyors found that even when appropriate care plan was ordered, it was often not implemented t
That included a female patient who fell in February, June and July who suffered a broken hip.
Again, the report states, the plan developed for the woman "was not appropriate" and she suffered two major in juries.
A resident "who was severely cognitively impaired initially admitted to the facility for rehabilitation after suffering a fractured hip, had a total of 10 falls between April 5 and June 13," the report states.
Still other deficiencies included failing to address the pain being suffered by one patient, failing to respond to excessive weight loss and not properly treating a patient with a pressure ulcer.
Contact: wfrochejr999@gmail.com













NASHVILLE, Tenn. – Tennessee Health Commissioner John Dreyzehner, MD, MPH has suspended new admissions of residents to Asbury Place at Maryville effective Sept. 12, 2018. In addition, Dreyzehner has imposed nine state monetary penalties in the amount of $5,000 each for a total assessment of $45,000. A special monitor has been appointed to review the facility’s
operations.

Asbury Place at Maryville, a 181 bed nursing home located at 2648 Sevierville Road in Maryville was ordered not to admit any new residents based on conditions found during a complaint survey conducted August 13 – August 20, 2018. The investigation was completed Sept. 4. During the investigation, surveyors found violations of the following standards: administration and basic services.

The Commissioner of Health may suspend admissions to a nursing home when conditions are determined to be, or are likely to be, detrimental to the health, safety or welfare of the residents. The order to suspend admissions remains effective until conditions have been and continue to remain corrected. A copy of the order must be posted at the public entrance where it can be plainly seen.

The nursing home has the right to a hearing regarding the suspension of admissions before the Board for Licensing Health Care Facilities or an administrative judge.

The mission of the Tennessee Department of Health is to protect, promote and improve the health and prosperity of people in Tennessee. TDH has facilities in all 95 counties and provides direct services for more than one in five Tennesseans annually as well as indirect services for everyone in the state, including emergency response to health threats, licensure of health professionals, regulation of health care facilities and inspection of food service establishments. Learn more about TDH services and programs at www.tn.gov/health.

###

Monday, September 10, 2018

Texas Compounder Licensed by TN RX Board

By Walter F. Roche Jr.

The Tennessee Pharmacy Board has licensed a Texas pharmacy to issue sterile compounded and other prescription drugs in the state even though the company says it has suspended the production of sterile drugs while its facilities are upgraded.
Records from the state board show Surecare Specialty Pharmacy of El Paso, Texas was issued a pharmacy license in early July. But you won't find Surecare listed among the licensed pharmacies on the board's website. It was removed from the automated listing shortly after a request was submitted for a copy of the application.
Asked why the listing was removed, Shelley Walker, a spokeswoman for the state Health Department, said the action was taken under the state law creating the pharmacy panel. She declined to be more specific.
The unusual handling of the Texas drug compounding firm comes in a state where drug compounding has become controversial. It was a Massachusetts drug firm that compounded fungus laden steroids that took the lives of 15 Tennessee patients in a 2012 outbreak. Dozens more were sickened.
More recently an unnamed out-of-state drug compounder provided the Tennessee Corrections Department with the drug, Midazolam, needed to execute Billy Ray Irick on Aug. 9. Under state law the identity of that compounder has been kept secret.
Repeated calls and emails to Surecare and its majority owner Paul Galbiati went unanswered.
The Surecare web site lists sterile compounding as one of its services, but also states, "We
are currently updating our clean room facilities to meet changes in standards and regulations – at which time we will continue to offer sterile compounding for our patients."
According to the company's application, a predecessor firm, Sun City Compounding, was cited by the Texas Pharmacy Board for failing to disclose the fact that an officer had been convicted of a misdemeanor.
Surecare's Tennessee application lists Alexandra Abbas as the pharmacist in charge.
Abbas was also cited by the Texas board in 2017 for allowing an unlicensed technician to perform technician's duties. She was employed in a different pharmacy at the time.
Though Abbas was listed as the pharmacist-in-charge in the Tennessee application, the company web site lists a different pharmacist in that position.
The application lists Galbiati as a 60 percent owner, 4AM Consulting with 30 percent, James A. Lyle at 5 percent and Ed Anderson with 5 percent. Neither Lyle or Anderson responded to requests for comment.
Contact: wfrochejr999@gmail.com

Admissions Halted at Memphis Assisted Living


By Walter F. Roche Jr.

Tennessee health officials have fined and suspended new admissions to a Memphis assisted living facility where a resident suffered a heat stroke and dehydration after being left unattended outside on a hot early summer day.
State Health Commissioner John Dreyzehner imposed a $3,000 fine and ordered the admissions freeze on Foxbridge Assisted Living and Memory Care, part of Inspirit Senior Living, based in McLean, Va.
According to a six-page inspection report, the 91-year-old resident was found unresponsive at about 3 p.m. on June 6 of this year while sitting on a dock near the cottage where he lived.
The report concludes the facility failed to provide a safe environment for the resident who suffered from dementia, high blood pressure and heart disease. He had been admitted to the facility on Nov. 30, 2017.
Inspirit President David Mcharg said that after reviewing the state report they have decided to appeal all claims.
"We will work cooperatively with the Department of Health to resolve this matter. We look forward to continuing to provide excellent care and remain dedicated to the quality of life of our residents," he wrote in an email response to questions.
According to the report the resident was diagnosed with heat stroke and dehydration after he was transferred to a local hospital. He was discharged six days later to a local nursing home.
One Foxbridge staff member told state surveyors they were not sure how long he had been sitting out in the sun on a day that a "Code Orange" had been declared. His body temperature, according to hospital records' ranged up to 103 degrees.
"He was real hot," one of the care providers told surveyors, "and his arms and face were red."
"He did not drink any water while he was outside," another employee told the state inspectors, adding that he used a cup of water to pour over the resident when he was found unresponsive.
The facility, located at 2180 Magnum Road, sits on an 8-acre site that includes five cottages and a fishing pond. The resident was living in a cottage which houses 20 seniors. Two staffers were on duty at the time of the incident.
According to the report the resident was placed on an office chair and rolled back to the cottage where he was laid on the floor and cooled with ice until emergency responders arrived.
"There was no documentation the resident frequently stayed outdoors or was monitored outdoors," the report concludes.
"Apparently he was exposed to a lot of heat and left for several hours," the report states.
The resident's wife told surveyors said that her husband was unconscious for two hours.
Contact: wfrochejr999@gmail.com