Failure to Attempt Non-Pharmacological Interventions Before PRN Antianxiety Medication
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary psychotropic medications by not attempting non-pharmacological behavioral interventions prior to administering 'as needed' antianxiety medication. Facility policy required that non-pharmacological approaches be used to minimize medication use, permit the lowest possible dose, and allow for discontinuation when possible. Despite this, review of the Medication Administration Record (MAR) for a cognitively impaired resident with dementia, who exhibited wandering behaviors and received both antipsychotic and antianxiety medications, showed multiple administrations of Ativan (Lorazepam) for restlessness and agitation over a period of time. There was no documented evidence that non-pharmacological interventions were attempted before administering Ativan on any of the recorded occasions. The physician's orders specifically required staff to monitor the resident's behavior every shift and document non-pharmacological interventions. The Director of Nursing confirmed that these interventions should have been attempted and documented prior to each administration of the medication, but this was not done.
Plan Of Correction
Unable to retroactively chart non-pharmacological interventions prior to administration of psychotropic medication. Residents who are ordered as needed (PRN) psychotropic have the potential to be affected. Education provided to licensed nurses on charting non-pharmacological interventions prior to the administration of a psychotropic medication. The Director of Nursing or designee will audit and review incident reports to ensure the necessary reporting is completed. Audits will be conducted as follows: 3.) Up to 5 records will be reviewed daily for 4 weeks. 4.) Then up to 10 records will be reviewed monthly for 2 months. Results of the audits will be provided by the Administrator and be presented for review at the monthly Quality Assurance Improvement Committee (QAPI) meeting monthly for a period of three months. Any revisions to the audit plan will be reviewed and implemented with the coordination of the interdisciplinary team at QAPI Committee meeting.