Failure to Provide Medical Justification for Declining Pharmacy-Recommended GDRs
Penalty
Summary
The facility failed to ensure that physicians provided clear and medically justified reasons for not implementing pharmacy-recommended gradual dose reductions (GDR) of psychotropic medications for two residents. In both cases, the pharmacist had reviewed the residents' drug regimens and recommended dose reductions based on the absence of documented behaviors and the presence of dementia diagnoses. However, the physicians either declined the recommendations without providing any reasoning or cited non-medical reasons, such as family requests, without further explanation. For one resident with multiple diagnoses including dementia, psychotic disturbance, and major depressive disorder, the pharmacist recommended reducing the dose of Quetiapine on several occasions, but the physician either gave no reason or referenced family wishes for not making changes. Another resident with severe cognitive impairment and several psychiatric diagnoses was also recommended for dose reductions of Duloxetine and Olanzapine, but the physician again declined without providing a medical rationale, sometimes citing resident or family requests. The DON confirmed that GDR recommendations were declined without appropriate medical reasoning.