Failure to Limit PRN Psychotropic Medication Orders to 14 Days
Penalty
Summary
The facility failed to ensure that residents' medication regimens were free from unnecessary psychotropic medications for two residents. According to the facility's policy, psychotropic medications such as anti-psychotics, anti-depressants, anti-anxiety agents, and hypnotics should only be prescribed when clinically indicated and, if ordered on a PRN (as needed) basis, should be limited to 14 days unless a physician provides a documented rationale for extending the order. For one resident with diagnoses including anxiety, hypokalemia, and spina bifida, a physician's order for Hydroxyzine 10 mg every four hours PRN for anxiety did not include a 14-day stop date or a documented rationale for continuation beyond 14 days. Similarly, another resident with anxiety, high blood pressure, and COPD had a physician's order for Hydroxyzine 10 mg every six hours PRN for anxiety, also lacking a 14-day stop date and physician justification for extension. These findings were confirmed through clinical record review and staff interview, specifically with the Director of Nursing, who acknowledged the failure to comply with requirements for psychotropic medication management. The absence of appropriate stop dates and physician documentation for PRN psychotropic medications resulted in non-compliance with both facility policy and regulatory requirements.