Failure to Conduct Gradual Dose Reduction and Verify Indication for Antipsychotic Medication
Penalty
Summary
A deficiency occurred when a resident was admitted to the facility with a physician's order for Risperidone, an antipsychotic medication, without a documented psychiatric diagnosis to support its use. The resident's diagnoses included cerebrovascular disease and dementia, and the PASRR Level 1 screening indicated no known or suspected mental health diagnosis. Despite this, the psychiatric APRN continued the Risperidone order for a diagnosis of Bipolar disorder, which was not supported by the hospital or facility clinical records. The clinical record review and interviews revealed that the psychiatric APRN did not verify the presence of a psychiatric diagnosis before continuing the antipsychotic medication. The APRN admitted to not reviewing the hospital discharge paperwork and simply continued the medication based on the hospital orders. Another APRN noted that the resident was admitted on Risperidone without a diagnosis and expected a gradual dose reduction should have been initiated, as the only diagnosis present was dementia without behavioral disturbances. Facility policy requires that psychotropic medications only be used when necessary to treat a specific, documented condition and that gradual dose reductions be attempted unless contraindicated. In this case, the required gradual dose reduction was not initiated upon admission, and the use of Risperidone was not supported by an appropriate diagnosis, resulting in a failure to comply with facility policy and regulatory requirements regarding unnecessary medications.