Failure to Limit PRN Antipsychotic Orders and Monitor Psychotropic Medication Use
Penalty
Summary
The facility failed to ensure that PRN (as needed) orders for antipsychotic medications were limited to a 14-day duration for one resident. Specifically, a resident with a diagnosis of bipolar disorder and schizophrenia had active PRN orders for Zyprexa that exceeded the 14-day limit on two occasions, with one order lasting 24 days and another lasting 16 days. The Director of Nursing (DON) confirmed that the facility did not adhere to the policy requiring PRN antipsychotic orders to be limited to 14 days, as the rationale for use may change within that period. Additionally, the facility did not monitor or document the target behavior or adverse effects related to the use of Ativan for another resident diagnosed with dementia and anxiety. The resident was prescribed Ativan for anxiety manifested by an inability to relax, but there was no documentation in the Medication Administration Record (MAR) to record or quantify the behavior or monitor for adverse effects. There were also no physician orders or care plans addressing the monitoring of the behavior or adverse effects related to Ativan use for this resident. The facility's policy on psychoactive medication management requires that PRN antipsychotic orders be limited to 14 days and that nursing staff document behaviors and adverse reactions in the MAR. The policy also specifies that behaviors and possible adverse drug reactions should be monitored every shift. The facility did not follow these requirements for the two residents involved, as confirmed by the DON during interviews.