Failure to Ensure Required Stop Date for PRN Antianxiety Medication
Penalty
Summary
A deficiency was identified when a resident with diagnoses of dementia, depression, and anxiety was administered a PRN (as-needed) antianxiety medication without a required 14-day stop date or a specified duration, and without documentation of the physician's rationale for extended use. The resident's electronic health record showed severely impaired cognition and dependence on staff for activities of daily living. The resident's care plan included directions for medication administration and monitoring, but the PRN order for Ativan lacked a stop date as required by facility policy. Review of the resident's records revealed that the PRN Ativan was ordered and administered multiple times over a period exceeding 14 days, with no evidence in the electronic health record of a specified duration or physician's rationale for continued use. The medication regimen review initially did not identify irregularities, but a subsequent review noted the missing stop date. Despite this, the medication continued to be administered without the required documentation. Interviews with nursing staff indicated a lack of clarity regarding which PRN medications required stop dates. The facility's policies specified that as-needed psychotropic medications should be limited to 14 days unless a longer duration is justified and documented by the physician. The failure to include a stop date or physician's rationale for the extended use of the PRN antianxiety medication constituted the deficiency.