Failure to Ensure CMS-Approved Indication for Antipsychotic Medication
Penalty
Summary
The facility failed to ensure that the Consultant Pharmacist (CP) recommended a Centers for Medicare and Medicaid Services (CMS) approved indication for an antipsychotic medication prescribed to a resident. The resident had a history of depression, quadriplegia, muscle weakness, dysphagia, and COPD, and was completely dependent on staff for all activities of daily living. The resident's medical record included an order for Seroquel, an antipsychotic, to be administered via gastrostomy tube at bedtime for depression. The CP's medication regimen review noted that Seroquel could not be used for depression, but did not acknowledge that depression is not an accepted CMS indication for antipsychotic use. The medical provider noted a failed gradual dose reduction, but the documentation did not address the lack of an appropriate indication for the medication. Interviews with nursing staff and administrative nurses confirmed that antipsychotic medications should not be used for depression and are intended for mental disorders such as behavioral and mood disorders. The facility's policy required the CP to complete monthly medication reviews and report irregular findings, including making recommendations based on medication indications. Despite these requirements, the CP did not ensure that the antipsychotic was prescribed for a CMS-approved indication, resulting in the continued administration of the medication for an unapproved use.