Failure to Address Pharmacy Recommendations and Medication Orders in a Timely Manner
Penalty
Summary
The facility failed to ensure that pharmacy recommendations were addressed in a timely and appropriate manner for multiple residents. For one resident with vascular dementia and schizoaffective disorder, pharmacy progress notes indicated recommendations for a gradual dose reduction (GDR) of Cymbalta, as required by federal regulation. The documentation for declining the GDR lacked a patient-specific rationale, and the form was reprinted and signed with inconsistent dates. Additionally, the facility was unable to locate a subsequent pharmacy recommendation for this resident. Another resident with multiple diagnoses, including major depressive disorder and generalized anxiety disorder, also had a pharmacy recommendation for a GDR of Cymbalta. The rationale for declining the GDR was not documented in the medical record, and the form was similarly reprinted and signed with earlier dates. Furthermore, repeated pharmacy recommendations for laboratory testing were not acted upon until several months later, despite being agreed to and signed by the provider. A third resident with sepsis, osteomyelitis, heart failure, and dementia received an antibiotic order for Macrobid that was outside the recommended dose or frequency and required dose adjustment based on renal function. There was no evidence in the progress notes that the dose was reviewed or clarified with the physician, and the medication was administered as ordered. The DON confirmed that the order was not addressed for proper dosing. Facility policies required timely review and documentation of pharmacy recommendations and medication orders, which was not consistently followed.