Failure to Document Rationale and Non-Pharmacological Interventions for PRN Psychotropic Use
Penalty
Summary
Surveyors identified that the facility failed to provide a clinical rationale for the continued use of as-needed (PRN) psychotropic medication beyond 14 days, as required by federal and state regulations. Specifically, for one resident with diagnoses including hypertension, congestive heart failure, and obstructive sleep apnea, a PRN order for clonazepam was renewed without documentation of the required clinical rationale for use beyond the 14-day limit. The medication was administered multiple times, but the clinical record did not include evidence that non-pharmacological interventions were attempted prior to each administration, as required by facility policy and regulation. Another resident, admitted with respiratory failure, heart failure, and chronic kidney disease, also received PRN clonazepam for restlessness at bedtime. The medication administration record showed several instances of use, but again, there was no documentation that non-pharmacological interventions were attempted before administering the medication. The facility's policy requires that such interventions be identified and attempted, and that their effectiveness be documented, but this was not reflected in the residents' records. During staff interviews, a registered nurse confirmed that the required stop date or clinical rationale for continued PRN use beyond 14 days was missing for one resident, and that both residents' records lacked evidence of attempted non-pharmacological interventions prior to PRN medication administration. These findings demonstrate noncompliance with federal and state requirements regarding the use of psychotropic medications and the documentation of non-pharmacological interventions.
Plan Of Correction
1. R 17 and R 29 were discharged. 2. At the time of the survey, the residents in house were reviewed and evaluated for documentation of alternative measures prior to administration of psychotropic prn medications. Orders were reviewed for an appropriate stop date of 14 days. 3. Licensed nursing staff will be provided education regarding the right to be free of chemical restraints, the requirements of alternative measures prior to administration of PRN psychoactive medications, and the 14-day stop date for all psychotropic prn medication orders. 4. The Director of Nursing or designee will audit new admission and all residents for orders with PRN psychotropic medications assessing the 14-day stop date as well as documentation of alternative interventions attempted weekly x 1 month, bi-weekly x 1 month, then monthly until substantial compliance is achieved. The results will be shared with the facility Quality Assessment and Performance Improvement Committee.