PRN Psychoactive Medication Order Exceeded Policy Limit Without Provider Justification
Penalty
Summary
The facility failed to ensure that an as-needed (PRN) psychoactive medication order for a resident did not exceed the facility's policy limit of 14 days. The resident, who had diagnoses including cognitive communication deficit, anxiety, and dementia with severely impaired cognition and total dependence on staff for activities of daily living, was initially prescribed lorazepam for agitation for 14 days. After the initial order was discontinued, a new order was placed for lorazepam every 6 hours PRN for 30 days, despite the absence of documented behaviors indicating agitation at the time of the new order and no documented rationale from the prescribing provider for exceeding the 14-day limit. Review of the resident's records showed that the extension to 30 days was requested by an LVN, not the psychiatric provider, and there was no documentation from the provider supporting the need for prolonged administration. The facility's policy required that any PRN psychoactive medication order not exceed 14 days unless the physician documented a reason for continued use. Interviews with staff confirmed that the extension was not justified by an increase in the resident's agitation or by provider documentation, and that it was outside the LVN's scope to request such an extension.