Lack of Physician Rationale for Not Following Pharmacy Recommendations
Penalty
Summary
The facility failed to ensure that the attending physician documented the rationale for not following pharmacy recommendations in the medical records for two of three residents reviewed. For one resident with diagnoses including depression, anxiety disorder, pulmonary hypertension, emphysema, and pulmonary fibrosis, the consultant pharmacist identified the use of Xanax as potentially inappropriate for older adults and recommended deprescribing. The attending physician disagreed with the recommendation, but no rationale was documented in the resident's medical record or on the recommendation form. For another resident with a history of urinary tract infection, traumatic subarachnoid hemorrhage, repeated falls, and hypertension, the pharmacist noted a duplication in therapy with Bupropion XL and Fluoxetine for depression and recommended a dose reduction. The attending physician again disagreed with the recommendation, but did not provide a rationale in the medical record. Interviews with the DON and the physician confirmed that rationales for disagreeing with pharmacy recommendations were not documented, as required by facility policy.