Failure to Document GDR Rationale and Limit PRN Antipsychotic Orders
Penalty
Summary
The facility failed to ensure that gradual dose reductions (GDR) for psychotropic medications were properly documented with a clinical rationale when not attempted for a resident with serious mental illness. Specifically, a resident with diagnoses of anxiety, bipolar disorder, and schizophrenia was receiving multiple psychotropic medications, including Haloperidol, Quetiapine, Clonazepam, and Lorazepam. Although GDRs for these medications were marked as contraindicated in communications with the prescribing provider, there was no documented clinical rationale in the resident's medical record explaining why dose reductions were not attempted. Additionally, the facility did not comply with requirements for limiting as-needed (PRN) antipsychotic medication orders to 14 days for another resident with severe cognitive impairment and diagnoses including Alzheimer's disease, dementia, anxiety, and depression. The resident was receiving a PRN antipsychotic combination (ABH gel) for agitation and restlessness, with the order in place and administered intermittently over several months. Despite repeated recommendations from the consultant pharmacist to add a stop date and renew the order every 14 days, the facility continued to administer the medication without proper renewal or documentation of appropriateness by the prescribing practitioner. Interviews with the Director of Nursing confirmed the lack of required documentation for both the clinical rationale for not attempting GDRs and the failure to renew PRN antipsychotic orders as mandated. These actions were inconsistent with the facility's own policy and regulatory requirements regarding the use and management of psychotropic medications.