Failure to Implement Gradual Dose Reduction for Psychotropic Medication
Penalty
Summary
The facility failed to ensure that a resident receiving psychotropic drugs underwent gradual dose reductions unless clinically contraindicated. This deficiency was identified during a recertification survey, where it was found that a resident with a diagnosis of Non-Alzheimer's Dementia and Major Depressive Disorder was receiving Seroquel and Valproic Acid for an unspecified mood disorder. Despite the absence of documented psychotic behaviors or mood symptoms that would justify the continued use of these medications, no attempts at gradual dose reduction were made. The resident's medical records and observations during the survey period showed no evidence of psychotic behavior, yet the resident continued to receive the prescribed antipsychotic medication. The psychiatric consultation notes indicated that the psychiatrist had recommended a gradual dose reduction of Seroquel, but the resident's son consistently refused this intervention. Interviews with the psychiatric nurse practitioner and the Director of Nursing confirmed that the resident's son opposed the dose reduction, preventing its implementation. The facility's failure to attempt a gradual dose reduction, despite the absence of clinical indications for continued use of the medication, constitutes a deficiency in adhering to regulatory requirements for the management of psychotropic medications.
Plan Of Correction
Plan of Correction: Approved January 3, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Immediate Correction 1) On 12/24/24, A care conference was held with Resident #153’s son, the psychiatric nurse practitioner, and the attending physician to discuss the necessity of a gradual dose reduction (GDR) and behavioral interventions. 2) On 12/14/24, The psychiatrist/psychiatric nurse practitioner documented the clinical justification for attempting the GDR. 3) On 12/24/24, All [MEDICAL CONDITION] medications and CCP were updated by the IDT team for Resident #153 to ensure compliance with requirements, and any necessary changes were documented in the clinical record. Identification of Others 1) Develop an audit tool of all residents currently prescribed [MEDICAL CONDITION] medications to identify those who: - Have not undergone a GDR, if clinically appropriate. - Lack documentation of behavioral symptoms or a specific [DIAGNOSES REDACTED]. - Have PRN orders for [MEDICAL CONDITION] medications exceeding 14 days without proper evaluation and documentation. 2) Immediate corrective actions will be implemented for identified residents, including care plan updates, medication reviews, and staff education. Systemic Changes 1) Review and revise the facility's policy on [MEDICAL CONDITION] medication use to include: - Guidelines for initiating and documenting GDRs. - Processes for handling refusals by family or residents, including obtaining written refusal documentation. 2) Provide training to RN's, LPN's, Psychiatrist and Dr's on the following: - Regulatory requirements for [MEDICAL CONDITION] medications and PRN orders. - Documentation standards, including behavioral monitoring and physician rationales. - Effective communication strategies for engaging families in care decisions. 3) Develop standardized communication audit to educate families about the benefits of GDRs and the risks of long-term [MEDICAL CONDITION] medication use. 4) The facility’s medical director will review the case to ensure adherence to regulations and provide oversight for future interventions. Quality Assurance 1) The pharmacy consultant will conduct monthly reviews of [MEDICAL CONDITION] medication use for all residents, including compliance with GDRs and PRN order limits. 2) The interdisciplinary team (IDT) will review [MEDICAL CONDITION] medication cases during quarterly care plan meetings. 3) Audits will be completed by the Director of Nursing weekly x 4 weeks; monthly x 3 months; and quarterly for x 1 year. Any negative findings will be addressed immediately. 4) Findings will be brought to the QAPI quarterly meeting for tracking of facility compliance. Person Responsible for this Ftag: 1) The Director of Nursing.