Failure to Limit PRN Psychotropic Medication Duration and Document Rationale
Penalty
Summary
The facility failed to ensure that as needed (PRN) psychotropic medications for a resident were limited to a 14-day duration, as required by facility policy. Specifically, a resident with diagnoses including Bipolar Disorder, Depression, and Anxiety Disorder received PRN Ativan (an antianxiety medication) for longer than 14 days without a documented physician assessment or rationale for continued use. The resident's medical record showed frequent administration of Ativan over several months, with no evidence of a stop date or justification for extending the PRN order beyond the policy limit. Additionally, the resident had two PRN orders for different antianxiety medications (Ativan and Diazepam), but only Ativan was administered during the review period. Interviews with facility staff, including the Social Service Director, Medical Director, and Pharmacist, revealed a lack of awareness and documentation regarding the rationale for the extended PRN orders. The Social Service Director was unaware of the orders exceeding 14 days, and the Pharmacist indicated uncertainty about the need for a stop date. The Medical Director deferred responsibility to the hospice physician, but no documentation from hospice provided a rationale for the ongoing PRN use. The facility's failure to follow its own policy and federal regulations regarding PRN psychotropic medication orders resulted in the deficiency.