Failure to Ensure Medically Necessary Use and Monitoring of Psychotropic Medications
Penalty
Summary
Surveyors identified that the facility failed to ensure that residents did not receive psychotropic medications unless medically necessary. Several residents were prescribed and administered psychotropic medications without appropriate psychiatric diagnoses documented in their medical records. For example, one resident received hydroxyzine for restlessness or anxiety despite not having a diagnosis of anxiety, and another received trazodone for sleep related to congestive heart failure without a psychiatric diagnosis or a documented rationale for continued PRN use beyond 14 days. The DON confirmed that staff are expected to ensure medications are ordered to treat a diagnosed condition and that PRN psychotropic medications should not be ordered for longer than 14 days without justification. Additionally, the facility did not consistently implement or document gradual dose reductions (GDR) for residents on long-term psychotropic medications. Multiple residents with psychiatric diagnoses such as anxiety, depression, and insomnia were maintained on medications like sertraline, trazodone, escitalopram, hydroxyzine, buspirone, lorazepam, mirtazapine, and Nuplazid for extended periods. Pharmacist recommendations for GDRs were either declined or not accompanied by patient-specific rationales from the prescribing providers. The DON confirmed that GDRs were not performed and that providers did not supply adequate justification for maintaining current dosages. Furthermore, one resident exhibited signs of excessive sedation, including frequent daytime sleepiness and missed meals, after being prescribed both alprazolam and hydroxyzine on scheduled regimens. The resident's POA reported increased sleepiness and was unaware of the frequency and combination of these medications, noting that the resident previously only received alprazolam as needed. Observations confirmed the resident was often asleep during the day, and the DON acknowledged the medication regimen and its effects.