Inaccurate Diagnosis of Delusional Disorder
Penalty
Summary
The facility failed to provide care and services in accordance with accepted professional standards of practice by inaccurately diagnosing a resident with delusional disorder without documented clinical evidence. The resident, who was admitted with Alzheimer's disease, was prescribed Olanzapine for delusional disorder, but there was no documented evidence of delusions or hallucinations to support this diagnosis. The consultant pharmacist recommended a diagnosis to justify the medication, but the resident's progress notes and psychological service provider's consult did not mention delusional disorder. The Director of Nursing confirmed that there was no documented evidence of a practitioner diagnosing the resident with delusional disorder, and the medical record should reflect accurate clinical findings. The comprehensive review of the resident's clinical record from admission through the survey period revealed no supporting clinical findings or practitioner verification for the diagnosis of delusional disorder, indicating a failure to meet professional standards of quality in the services provided.
Plan Of Correction
Resident 44's Olanzapine has begun to be titrated down until it can be discontinued since there is no supporting diagnosis. An education to licensed nurses and attending physicians will be completed for appropriate diagnosis of antipsychotics. An audit of the last 30 days of new admissions will be completed for appropriate diagnosis for antipsychotics. Any discrepancies will be corrected. New admits will be audited by the DON/designee for appropriate diagnosis for antipsychotics x 3 months. Any discrepancies will be corrected. Results of these audits will be reviewed at QAPI x 3 months.