Failure to Provide Nonpharmacological Interventions Before PRN Psychotropic Medication Administration
Penalty
Summary
Facility staff failed to provide nonpharmacological interventions prior to administering Lorazepam PRN for anxiety to a resident with multiple psychiatric diagnoses, including anxiety, depression, psychosis, delusional disorders, and auditory hallucinations. The resident, who had severely impaired cognition and was dependent on staff for most activities of daily living, was prescribed Lorazepam via gastrostomy tube as needed for episodes of crying. Review of the Medication Administration Record and Order Summary Report showed that for 37 days, staff did not attempt or document nonpharmacological interventions before giving the medication. Interviews with the RN Supervisor and the Director of Nursing confirmed that nonpharmacological interventions should have been provided prior to administering psychotropic medications, as outlined in the facility's policy and procedure. The policy indicated that such approaches are to be used to minimize medication use, permit the lowest possible dose, and allow for discontinuation when possible. The failure to implement these interventions was not explained by staff, and the omission was acknowledged by facility leadership.