Physician Failure to Respond to Monthly Medication Regimen Reviews
Penalty
Summary
The facility failed to ensure that physicians responded to monthly medication regimen reviews (MMRs) for three of five sampled residents who were reviewed for unnecessary medications. According to facility policy, non-urgent recommendations from the consulting pharmacist must be addressed by the attending physician in a timely manner and documented in the medical record. If the physician does not address or document a rationale for rejecting a recommendation, the Director of Nursing (DON), Medical Director, or designee is required to review the incomplete documentation with the physician. However, for the residents in question, there was no documented response from the physician to the pharmacist's recommendations for gradual dose reductions of medications such as citalopram, temazepam, and trazodone, despite multiple requests noted in the MRRs. The residents involved had diagnoses including major depressive disorder, insomnia, and post-traumatic stress disorder, and were receiving medications such as hypnotics and antidepressants. Assessments indicated that these residents were cognitively intact, with one showing no depression symptoms and another with mild depression symptoms. Despite the pharmacist's repeated recommendations for gradual dose reductions, there was no evidence in the medical records or MRR reports that the physicians addressed or documented responses to these recommendations. Interviews with the DON confirmed that physician responses to the MMRs could not be located.