Failure to Ensure Drug Regimens Free from Unnecessary Antipsychotic Medications
Penalty
Summary
The facility failed to ensure that residents' drug regimens were free from unnecessary medications by administering duplicate antipsychotic therapy without documented clinical justification and by not attempting gradual dose reductions (GDR) where appropriate. For one resident with schizophrenia and Parkinson's disease, the clinical record showed concurrent prescriptions for two antipsychotic medications, Seroquel and Haldol, in addition to other psychoactive drugs. The antipsychotic medication review indicated that dose reduction was contraindicated, but there was no resident-specific documentation or individualized clinical rationale to support this assertion. The facility was unable to provide evidence that the physician had documented a justification for continued antipsychotic use at current dosages or for the necessity of prescribing both antipsychotics concurrently, and no GDR had been attempted. Another resident with Alzheimer's disease, anxiety, and on hospice care was prescribed Seroquel for dementia and later Haldol for behavioral symptoms. The clinical record documented persistent behavioral symptoms and repeated increases in antipsychotic dosages, resulting in duplicate antipsychotic therapy. Despite these medication changes, there was no evidence of hallucinations, delusions, or other psychotic symptoms that would warrant antipsychotic use. The record also lacked documentation of nonpharmacological interventions being attempted or considered prior to initiating or escalating pharmacologic treatment. Observations revealed extrapyramidal symptoms, but there was no evidence that the medication regimen was reassessed in response. Interviews with the DON confirmed the absence of physician documentation supporting the clinical need for duplicate antipsychotic therapy or repeated dosage increases for both residents. The facility's actions did not align with its own policy requiring ongoing evaluation and documentation of psychotropic medication use, including the use of nonpharmacological interventions and individualized clinical rationales for medication decisions.