Failure to Include 14-Day Stop Date on PRN Psychotropic Medication Orders
Penalty
Summary
The facility failed to ensure that as-needed (PRN) antianxiety medication orders for two residents included a required 14-day time limit, as mandated for psychotropic medications. For one resident with multiple diagnoses including psychotic disorder, major depressive disorder, epilepsy, and vascular dementia, the electronic medical record showed an active PRN order for Ativan (lorazepam) without a 14-day discontinuation date. This resident had severely impaired cognition and required significant assistance with daily activities. The care plan noted the use of high-risk medications and directed staff to limit dosages and durations, but the PRN Ativan order did not comply with the 14-day requirement. A second resident, with diagnoses including hemiplegia following a stroke, major depressive disorder, and insomnia, also had a PRN Ativan order lacking a 14-day stop date. This resident had intact cognition but required substantial to total assistance with functional abilities and had a history of behavioral issues. The care plan directed staff to administer medications as ordered and monitor for side effects, but the PRN order for Ativan did not include the necessary time limitation. Interviews with nursing staff and administration confirmed that the responsibility for ensuring correct order entry, including the 14-day stop date for PRN psychotropic medications, rested with the nurse taking off the order. Both the facility's policy and staff statements acknowledged the requirement for a 14-day limit on PRN psychotropic medications, but this was not implemented for the two residents in question.