Failure to Obtain Proper Informed Consent Prior to Administration of Psychotropic Medications
Penalty
Summary
Licensed nurses at the facility failed to ensure that informed consent was properly obtained from residents or their responsible parties prior to administering antipsychotic and psychotropic medications. In several cases, consents were either obtained after the medications had already been administered or were obtained by licensed nurses rather than the prescribing provider, contrary to facility policy. For example, one resident with dementia and schizophrenia, who lacked capacity to make medical decisions, received multiple psychotropic medications, including Ativan, Divalproex Sodium, and Zyprexa, before the responsible party was informed or consented. The responsible party later stated they were not made aware of the medications being administered. Another resident with vascular dementia and schizoaffective disorder, who was determined to have the capacity to make medical decisions, was administered Prozac and Seroquel before informed consent was obtained. Documentation showed that the medications were given prior to the date the consent was signed, and the Assistant Director of Nursing confirmed that consent should have been obtained beforehand. Similarly, a third resident with dementia and schizophrenia, who was not capable of making medical decisions, received Divalproex Sodium and Quetiapine Fumarate before any informed consent was documented. In one instance, the provider's signature on the consent form was dated well after the medication had already been administered. Facility policy required that the prescribing clinician obtain and document informed consent from the resident or their representative prior to the administration of psychotropic medications, including a review of non-pharmacological alternatives, risks, benefits, and the right to refuse. However, the review found that these procedures were not consistently followed, with licensed nurses sometimes obtaining consent instead of the provider, and medications being administered before consent was documented. These actions resulted in residents receiving antipsychotic and psychotropic medications without being fully informed or having the opportunity to consent or refuse, as required by facility policy.