Failure to Document Required Stop Dates for PRN Psychotropic Medications
Penalty
Summary
The facility failed to adhere to its policy regarding the administration of PRN psychotropic medications, specifically Lorazepam, for two residents. The policy mandates that orders for psychotropic drugs are limited to 14 days unless a clinical rationale for continued use is documented. For Resident R8, who has diagnoses including heart failure, atrial fibrillation, and anxiety, a physician's order dated 11/12/24 prescribed Lorazepam 0.25 ml by mouth every 2 hours as needed for anxiety. This order did not include the required stop date within 14 days or a documented clinical rationale for its continuation beyond this period. Similarly, Resident R15, diagnosed with dementia, osteoarthritis, and hypothyroidism, had a physician's order dated 11/15/24 for Lorazepam 0.25 mg by mouth every 12 hours as needed for anxiety. This order also lacked the necessary 14-day stop date or a clinical rationale for continued use beyond 14 days. The Nursing Home Administrator confirmed these deficiencies during an interview, acknowledging the absence of the required documentation for both residents.
Plan Of Correction
1) R15 and R8 stop dates to be added to Lorazepam. 2) All PRN psychotropic medications will be audited to ensure there is a stop date in place or documentation with rationale to continue the medication. 3) The nurses will be trained by the Director of Nursing/designee on ensuring there is a stop date in place for all PRN psychotropic medications unless there is documentation with rationale to continue the medication. 4) The Director of Nursing/designee will audit all new orders to ensure there are stop dates for all residents on PRN psychotropic medications and rationale to support continued use; 1x weekly for 3 weeks then 1x monthly x2. 5) Results of the audits to be reviewed at quarterly QAPI meeting.