Failure to Limit PRN Psychotropic Medication and Monitor Effects
Penalty
Summary
The facility failed to comply with regulations regarding the administration of psychotropic medications, specifically concerning PRN orders and monitoring of medication effects. A review of the facility's policy on the use of psychotropic medications indicated that these drugs should only be used when nonpharmacological interventions are clinically contraindicated and must be prescribed to treat a resident's specific, diagnosed condition. However, the facility did not adhere to these guidelines, as evidenced by the case of a resident who was administered Lorazepam for anxiety without a documented rationale for extending the PRN order beyond the 14-day limit. The resident in question, who was admitted with diagnoses including Alzheimer's disease, heart failure, and diabetes mellitus, was receiving multiple psychotropic medications, including Escitalopram, Quetiapine, and Lorazepam. The clinical record review revealed that the Lorazepam order, which started in June of the previous year, was not discontinued until April of the following year, exceeding the 14-day PRN limit without proper documentation or a stop date. This oversight indicates a failure to ensure that PRN orders for psychotropic drugs are appropriately limited and justified. Additionally, the facility did not adequately monitor the effectiveness or adverse consequences of the psychotropic medications administered to the resident. The care plans for antipsychotic, antianxiety, and antidepressant medication use included goals and interventions to monitor and document side effects and effectiveness. However, the clinical record lacked evidence of such monitoring, as confirmed by the Director of Nursing during an interview. This deficiency highlights a significant lapse in the facility's responsibility to ensure the safe and effective use of psychotropic medications for its residents.
Plan Of Correction
1. Resident R2 did not experience any adverse effects. R2's PRN order was fixed to 14 day time limit. Care plan updated and facility implemented documentation of monitoring of med effectiveness. 2. DON/designee to educate licensed staff on PRN orders for psychotropic drugs limited to 14 days and to monitor effectiveness or adverse consequences of psychotropic medications and to document monitoring/med effectiveness. 3. DON/designee to conduct house audit on residents on psychotropic meds to ensure all PRN orders have the required 14 day time limit and care plan/documentation regarding med effectiveness. 4. DON/Designee to audit psychotropic drug usage to ensure PRN orders have the required 14 day time limit and care plan/documentation regarding med effectiveness daily x 1 week, 3x/week for 2 weeks, then monthly x 2 months. 5. Results to be submitted to QAPI for review and approval.