Failure to Limit PRN Psychotropic Medication Duration and Document Physician Rationale
Penalty
Summary
The facility failed to limit the duration of a PRN psychotropic medication to 14 days and did not ensure that the physician documented a rationale to extend the use of the medication for one resident. The medical record review showed that a resident with major depressive disorder and early-onset Alzheimer's, who had severe cognitive impairment, had an active physician order for Lorazepam (Ativan) 0.5 mg to be given every 4 hours as needed for anxiety. This order was initiated and remained active beyond the 14-day limit without evidence of discontinuation or physician documentation justifying continued use. The Director of Nursing confirmed that the order should have been discontinued after 14 days and reevaluated for continued use.
Plan Of Correction
F605 – Right to be Free from Chemical Restraints Element #1: The PRN order for Lorazepam for Resident #33 was discontinued after review and discussion with the physician. Element #2: The Director of Nursing initiated a full audit of all psychotropic medications with PRN orders on to ensure compliance with PRN orders. Any noncompliant orders were corrected immediately. Element #3: The Psychotropic Medication Policy was reviewed by the Administrator and revised as necessary. Licensed Nurses and Providers were re-educated on the regulation F605 and