Failure to Monitor for Antipsychotic Side Effects and Tardive Dyskinesia
Penalty
Summary
The facility failed to ensure that a resident receiving antipsychotic medication was appropriately and timely monitored for side effects, specifically for signs and symptoms of tardive dyskinesia. The resident, who had diagnoses including depression, vascular dementia, neuroleptic induced parkinsonism, and drug-induced subacute dyskinesia, was observed exhibiting involuntary lip-smacking movements. Despite these symptoms, the facility did not complete the required Abnormal Involuntary Movement Scale (AIMS) assessments at the recommended quarterly intervals, resulting in an eight-month gap between assessments. Facility policy required baseline and quarterly AIMS assessments for residents on antipsychotic medications, as well as additional assessments as needed or as ordered by a physician. The resident's care plan also included monitoring for adverse reactions to psychotropic medications, such as tardive dyskinesia. However, the electronic medical record showed no documentation of monitoring for adverse reactions or side effects during the period in question, and there was no physician order for antipsychotic medication side effect monitoring in the resident's current orders. Staff interviews confirmed that AIMS assessments should be completed quarterly and that it was the responsibility of nursing staff, overseen by the DON, to ensure these assessments were performed. The DON acknowledged that the EMR system failed to alert staff when the assessment was due, resulting in the missed monitoring. The lack of timely and appropriate monitoring for antipsychotic side effects led to the deficiency identified during the survey.