Inappropriate Use of Psychotropic Medications Without Proper Diagnoses
Penalty
Summary
The facility failed to ensure that residents receiving psychotropic medications had appropriate diagnoses to justify their use. Medical record reviews revealed that several residents were prescribed medications such as escitalopram and Depakote for conditions like depression, agitation, mood, and behaviors, without corresponding or appropriate clinical diagnoses documented in their records. For example, one resident was prescribed escitalopram for depression despite not having a diagnosis of depression, and Depakote was ordered for several residents with indications such as agitation, mood, and behaviors, which are not approved indications for the medication. Care plans for these residents did not consistently address the use of these psychotropic medications or specify the behaviors or symptoms being treated. In some cases, the care plans mentioned potential side effects and monitoring interventions but failed to link these to specific, clinically justified diagnoses. Interviews with the DON confirmed that terms like "behaviors," "agitation," and "mood" were not appropriate diagnoses for the use of Depakote, and that some residents were receiving medications without a proper diagnosis to support their use. Review of prescribing information for Depakote indicated that its approved uses are for the treatment of seizures, prophylaxis of migraine headaches, and treatment of manic episodes associated with bipolar disorder. The facility's own policy on psychotropic medication use requires that such medications be prescribed with a documented clinical indication consistent with accepted clinical standards of practice. The lack of appropriate diagnoses and documentation for the use of these medications constituted a deficiency in the facility's medication management practices.