Failure to Notify Responsible Party of Seizure Medication Discontinuation
Penalty
Summary
The facility failed to notify a resident's Responsible Party (RP) when the resident's seizure medication, Levetiracetam (Keppra), was discontinued. The resident, who had a complex medical history including chronic obstructive pulmonary disease, chronic respiratory failure, ischemic heart disease, prior strokes, and a history of seizures, was initially admitted with orders for Keppra following a hospitalization for seizures and metabolic encephalopathy. The hospital physician had recommended that any decision to discontinue Keppra should be made after a neurology consult, but no such consult was ordered or initiated after the resident's return to the facility. On a later date, a verbal order was entered by a nurse to discontinue Keppra, but there was no documentation of who gave the order, and the RP was not notified of this significant medication change. Interviews revealed that the nurse believed the order was given by a nurse practitioner (NP), but the NP did not recall giving the order and confirmed that she had not discussed discontinuing Keppra with the RP. The resident subsequently experienced another seizure, was hospitalized, and the RP only learned of the medication discontinuation after the resident was admitted to the hospital. The resident's physician was also unaware of the medication discontinuation until after the resident's hospitalization. Documentation in the facility records confirmed that the RP was not notified at the time of the medication change, and the lack of communication prevented the RP from advocating for the resident, as she would have informed the facility that discontinuation should not occur without a neurologist's evaluation. The failure to notify the RP of the medication discontinuation directly contributed to the resident's subsequent seizure and hospitalization.