Failure to Implement Time-Limited PRN Psychotropic Medication Orders
Penalty
Summary
The facility failed to ensure that each resident's medication regimen was managed and monitored to promote or maintain their highest practicable mental, physical, and psychosocial well-being. Specifically, two residents were identified during a recertification survey as having as-needed psychotropic medication orders without specified stop dates, contrary to the facility's policy and procedure. Resident #59, who was admitted with dementia, anxiety disorder, and depression, had an order for lorazepam to be administered as needed for agitation, but the order lacked an end date. The medication was administered multiple times over November and December 2024 without a specified stop date. Similarly, Resident #86, also diagnosed with dementia, anxiety disorder, and depression, had an order for Risperidone to be given as needed for agitation/anxiety, with the order documented as indefinite. Despite a pharmacy consultant's recommendation to apply an end date, the Nurse Practitioner disagreed, citing concerns about the medication not being renewed. This lack of adherence to the requirement for time-limited as-needed psychotropic medication orders was acknowledged by the Nurse Practitioner during an interview, indicating awareness of the Centers for Medicare and Medicaid requirement.
Plan Of Correction
Plan of Correction: Approved January 16, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 1. Residents #59 and #86 Medication Administration Orders were corrected to ensure 14 day limits were included as required for their as-needed (PRN) [MEDICAL CONDITION] medication orders. 2. All current resident medication administration orders were reviewed for as needed [MEDICAL CONDITION] medications to ensure 14 day stop dates are in place. 3. All medical providers re-educated on requirement that [MEDICAL CONDITION] medications given on an as needed basis must have an end date specified in the order not to exceed 14 days, along with other policy requirements. All nurses who have the potential to enter orders (Registered Nurses, Licensed Practical Nurses) will be re-educated on the requirements in [MEDICAL CONDITION] medication order entry. 4. All new orders for “as needed” [MEDICAL CONDITION] will be audited weekly from medical provider order summary, in addition to the pharmacist’s drug regimen review process (on admission and monthly) which will identify any non-conforming order. Any pharmacist finding and recommendation pertaining to as needed [MEDICAL CONDITION] medications will be brought to the direct attention of the Director of Nursing or her designee. Results of the reviews will be reported to the Quality Assurance & Performance Improvement Committee; 100% of new as needed [MEDICAL CONDITION] orders will be reviewed for compliance with policy for 6 months; frequency of audit to be re-evaluated at 6 months by Quality Assurance & Performance Improvement Committee based on audit results. Responsible Party: Director of Nursing