Lack of Clinical Justification for Antidepressant Use
Penalty
Summary
The facility failed to ensure proper documentation and clinical justification for the continued use of multiple antidepressant medications for a resident diagnosed with acute dementia. The resident, who was severely cognitively impaired, was prescribed Mirtazapine, Trazadone, and Sertraline for depression. Despite recommendations from the consultant pharmacist for a gradual dose reduction (GDR) of Mirtazapine and Trazadone, these requests were declined by the RN nurse practitioner and physician assistant, respectively. The reasons provided were that a GDR was contraindicated due to recent hospitalization for behavior against staff and that the resident's psych medications were managed by a consultant psychiatrist. The pharmacy consultant report did not include a resident-specific rationale to justify the continued use of multiple antidepressants, and there was no documented evidence to support the concurrent use of these medications. An interview with the Director of Nursing confirmed the lack of clinical justification from the attending physician for the continued administration of the antidepressants. This deficiency was identified during a survey, highlighting the facility's failure to comply with regulations regarding unnecessary medication use.
Plan Of Correction
Resident 19 documentation from facility MD for declination of GDR and use of multiple antidepressants has been added to clinical record. To identify other residents that have the potential to be affected, the DON/designee will complete an audit of concurrent antidepressant medications to ensure justification of use. To prevent this from reoccurring, the DON/designee will educate ADON and MD on proper documentation required for continued use of multiple antidepressant medications. MD will be responsible to comply with the regulation. To monitor and maintain ongoing compliance, the DON/designee will audit pharmacy recommendations for residents with concurrent antidepressant medications monthly x 4 to ensure all MD documentation of declination of GDR and justification of continued use. Any missing documentation will be brought to the Medical Director for review. All results will be brought to QAPI committee.