Inappropriate Use of Psychotropic Medication as Chemical Restraint
Penalty
Summary
The facility failed to prevent the use of unnecessary psychotropic medications, resulting in the over-sedation and decline in physical functioning of a resident, identified as R12. R12 was admitted with diagnoses including conversion disorder with seizures, generalized anxiety, and unspecified dementia with behavioral disturbances. Initially, R12 was prescribed Risperdal 2 mg orally for unspecified dementia with behavioral disturbances. However, after an increase in aggressive behaviors and a subsequent psychiatric hospitalization, the medication was changed to Risperidone 125 mg administered subcutaneously once a month. Observations and interviews revealed that R12 exhibited behaviors such as agitation, cursing staff, restlessness, and hallucinations. Despite these behaviors, R12's Minimum Data Set (MDS) assessments documented no physical or verbal behavioral symptoms directed towards others, and no rejection of care. The facility's social services and nursing staff confirmed that R12's behaviors included false allegations and yelling during care, but there was no evidence of self-harm or aggression towards other residents. The change in medication form was due to R12's refusal to take the oral medication. The administration of the antipsychotic injection led to R12 experiencing significant sedation, as noted in nurse's notes and staff interviews. R12 was observed to sleep for extended periods post-injection, which contributed to a decline in her physical condition and ability to perform activities of daily living. The facility's failure to appropriately monitor and adjust the use of psychotropic medication for R12, in accordance with their own procedures, resulted in the use of a chemical restraint that was not required to treat medical symptoms or behavior manifestations of mental illness.