Lack of Physician Rationale for Extended PRN Psychotropic Medication Orders
Penalty
Summary
The facility failed to ensure that a resident was free from unnecessary psychotropic medications by not documenting the physician's clinical rationale when extending PRN lorazepam orders beyond 14 days. According to the facility's policy, PRN orders for psychotropic drugs should be limited to 14 days unless the prescribing practitioner documents the rationale and indicates the duration for the extended order. Medical record review showed that the resident had multiple PRN lorazepam orders renewed and administered over several periods, but there was no documentation of the clinical rationale for these extensions in the medical record. The resident in question was noted to lack capacity to understand and make decisions, and had a history of anxiety manifested by hyperventilation, for which lorazepam was prescribed and administered via gastrostomy tube. Despite repeated renewals of the PRN lorazepam orders, the required physician documentation justifying the continued use was not present in the medical record, as confirmed by a registered nurse during interview and record review.