Failure to Obtain Consent and Follow Standards for Psychotropic Medication Administration
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment and multiple diagnoses, including dementia and anxiety, was administered lorazepam by injection without proper adherence to professional standards of nursing practice. The resident had an order for lorazepam by mouth as needed for anxiety, but during an episode of agitation, the nurse obtained a telephone order to administer lorazepam subcutaneously. There was no documentation that non-pharmacological interventions were attempted prior to administering the medication, nor was there evidence that the oral form was offered as required by facility policy. Additionally, the resident's representative was not given the opportunity to accept or decline the change in the medication administration route before the injection was given. The nurse involved stated that the resident could not refuse the medication because it was ordered by the physician, and the Director of Nursing confirmed that administering a psychotropic medication in a manner that prevented refusal constituted a chemical restraint. This practice did not meet professional standards and violated the resident's rights regarding informed consent and medication administration.