Failure to Notify Physician of Medication Refusals in Resident with Dementia and Behavioral Disturbances
Penalty
Summary
The facility failed to promptly notify the physician of a change in condition for a resident who repeatedly refused multiple prescribed medications. The resident, who had diagnoses including severe dementia with behavioral disturbances, schizophrenia, major depressive disorder, and bipolar disorder, exhibited daily episodes of roaming and had a history of rejecting necessary care. Despite clear documentation in the Medication Administration Record (MAR) that the resident refused significant numbers of doses of donezepril, quetiapine, depakote, and trazodone throughout the month, there was no evidence that the physician was notified in a timely manner as required by facility policy. Interviews with facility staff, including a CNA, LVN, RN, and the ADON, confirmed that the resident was non-compliant with care, frequently wandered, and required frequent redirection. Staff acknowledged that the resident's medication refusals should have been documented as a change of condition, and that the physician and responsible party should have been notified. The MAR showed that the resident refused donezepril for six consecutive shifts and had increased episodes of roaming, but these refusals were not documented in the nursing progress notes, nor was there evidence of physician notification. The nurse practitioner responsible for the resident stated that he expected to be notified of medication refusals to prevent withdrawal and manage the resident's behavior. He indicated that lack of notification may have contributed to increased wandering and hypersexual behaviors, which ultimately led to an incident involving another resident. Facility policies reviewed indicated that medication refusals must be reported to the prescriber after three doses are refused, and that the attending physician should be promptly informed of any change in condition. The failure to follow these policies resulted in delayed treatment and placed the resident at risk of harm.