Failure to Resubmit PASRR Level II After New Mental Health Diagnosis
Penalty
Summary
The facility failed to ensure that a Preadmission Screening and Resident Review (PASRR) Level II referral was resubmitted after a resident received a new mental health diagnosis. The resident was originally admitted with a diagnosis of depression and had a PASRR Level I completed, with a Level II process that was halted. Upon readmission, the resident was diagnosed with bipolar disorder and was prescribed Risperdal, an antipsychotic medication, for this new diagnosis. Medical records and assessments confirmed the new diagnosis and the administration of antipsychotic medication. Despite these significant changes, the required PASRR Level II resubmission was not initiated. Interviews with facility staff, including the psychiatric nurse practitioner, DON, and Administrator, revealed that the new diagnosis was not communicated to the appropriate personnel responsible for initiating the PASRR Level II process. As a result, the necessary referral and review were not completed in a timely manner following the resident's change in mental health status.