Failure to Limit PRN Antipsychotic Medication to 14 Days
Penalty
Summary
A deficiency was identified when a resident with diagnoses including cerebral infarction, unspecified dementia with psychotic disturbance, and hemiplegia/hemiparesis was administered PRN Risperdal (an antipsychotic medication) without a required 14-day stop date. The resident, who was under hospice care, had a physician's order for PRN Risperdal entered into the electronic medical record with instructions not to discontinue without consulting hospice, but no stop date was specified. The facility's policy, consistent with CMS guidelines, requires all PRN antipsychotic orders to be limited to 14 days unless a prescriber evaluation is conducted and a new order is written. Despite pharmacy notification to the facility regarding the 14-day limitation and the need for prescriber evaluation, the PRN Risperdal order remained active and was administered on multiple occasions over a two-month period. The Director of Nursing was unable to obtain documentation of a prescriber evaluation after 14 days and confirmed that neither the hospice provider nor the facility nurse practitioner had added a stop date for the PRN Risperdal. This failure to ensure compliance with the 14-day stop date requirement for PRN antipsychotic medication resulted in the cited deficiency.