Failure to Limit PRN Psychotropic Medication Order to 14 Days
Penalty
Summary
The facility failed to ensure compliance with federal regulations regarding the administration of psychotropic medications, specifically Ativan (lorazepam), for a resident diagnosed with dementia, anxiety disorder, and psychosis. The resident, who had severe cognitive impairment and lacked decision-making capacity, had a physician order for Ativan 0.5 mg to be given orally every eight hours as needed for inconsolable yelling. The order, dated 4/8/2025, did not include a required 14-day limitation for PRN (as needed) use, nor was there documentation of the prescriber's rationale or specified duration for extending the order beyond 14 days, as mandated by both federal regulation and the facility's own policy. During interviews and record reviews, it was confirmed that the Ativan PRN order remained active without an end date or appropriate documentation to justify its continuation past 14 days. The Director of Nursing acknowledged that the order should have been limited to 14 days and that the necessary documentation for extension was missing. The facility's policy, consistent with federal requirements, clearly states that PRN orders for psychotropic medications must be limited to 14 days unless properly justified and documented by the prescriber.
Plan Of Correction
F758: Free from Unnecessary Psychotropic Meds/PRN Use {F 758) CORRECTIVE ACTIONS: On 04/16/2025, Resident 77's Ativan order was followed up with MD and a new order was obtained with a duration of 14 days. OTHER RESIDENTS AFFECTED IDENTIFICATION: On 4/16/2025, all residents with PRN orders of psychotropics were audited and no other residents were noted to be affected by the deficient practice. All other residents with PRN psychotropics are noted with a 14-day stop date. Measures and Systemic Changes: The DON/Designee initiated education to licensed staff on 4/17/25 to ensure that any residents receiving PRN psychotropics must have a 14-day stop date initially upon ordering, and MD has to have a documentation of the rationale on the resident's medical records if MD wishes to continue its PRN use. The DON/DSD will monitor daily all new orders for PRN psychotropics prescribed to ensure the order is limited to 14 days. This will be followed by bimonthly reviews for 2 months, then monthly reviews for 3 months, and quarterly thereafter. MONITORING PERFORMANCE: The DON/SSD will present the results to the QA Committee for monthly review for the next 3 months and quarterly thereafter or until substantial compliance is achieved.