Failure to Provide Non-Pharmacological Interventions Before PRN Psychotropic Medication Administration
Penalty
Summary
The facility failed to ensure that a resident was free from chemical restraints by not providing non-pharmacological interventions prior to administering as-needed (PRN) psychotropic medication, specifically Lorazepam, for anxiety. The resident, who had a history of unspecified dementia with psychotic disturbance, schizoaffective disorder, generalized anxiety disorder, and COPD, was observed to have severely impaired cognitive skills and required significant assistance with daily activities. Multiple orders for Lorazepam were documented over several months, with the medication being administered for symptoms such as restlessness and inability to relax. Observations revealed that the resident was frequently sleepy or unresponsive during the day, requiring staff to repeatedly wake her for meals and activities of daily living. Staff interviews confirmed that non-pharmacological interventions were not attempted or documented before administering Lorazepam. Licensed nursing staff acknowledged that the medication could cause oversedation, impacting the resident's ability to participate in daily activities, and that the lack of non-pharmacological interventions could constitute a chemical restraint. Further interviews with facility staff, including the DON and pharmacist consultant, confirmed that best practice and facility policy require non-pharmacological interventions to be used before administering PRN psychotropic medications. Review of the facility's policy indicated that preventable causes of behavior should be considered and non-medication interventions implemented in collaboration with the healthcare team. The failure to follow these procedures resulted in the resident being at risk for adverse effects from unnecessary and prolonged use of psychotropic medication.