Failure to Document Rationale for Extended PRN Psychotropic Medication
Penalty
Summary
The facility failed to comply with the regulatory requirements for the administration of psychotropic medications, specifically regarding the extension of PRN orders beyond 14 days without proper documentation. The deficiency was identified in the case of a resident diagnosed with anxiety disorder and depression, who had a physician's order for Lorazepam gel every 2 hours as needed for agitation/anxiety. This order, which began on January 28, 2025, did not include an end date, and the physician did not provide a rationale for extending the PRN order beyond the 14-day limit as required by the facility's policy and federal regulations. A review of the resident's electronic medical record revealed a pharmacist's recommendation for a gradual dose reduction of psychoactive medications, which the physician declined without providing a documented rationale. The lack of a documented rationale and duration for the extended PRN order was confirmed during an interview with the Nursing Home Administrator, who acknowledged that the expectation was for the physician to provide such documentation. This oversight resulted in the facility's non-compliance with the requirement to ensure that PRN psychotropic medications are appropriately justified and time-limited.
Plan Of Correction
This provided submits the following plan of correction in good faith and to comply with Federal regulations. This plan is not an admission of wrongdoing nor does it reflect agreement with the facts and conclusions stated in the statement of deficiencies. 1. Resident 92's physician gave an end date for the residents Lorazepam medication. 2. To identify other residents that have the potential to be affected, the DON/designee will audit psychoactive medications ordered by resident 92's physician to ensure they have an end date. 3. Physicians will be educated by DON/designee on the importance of including an end date on psychoactive medications. 4. The DON/designee will conduct an audit 1x a week for 4 weeks of any new admissions with psychoactive medications and current residents who receive a new order for psychoactive medications to ensure physicians ordered stop dates on these medications. Results of the audits will be reviewed at the QAPI meeting to determine if future action/audits are needed.