Failure to Address PRN Psychotropic Medication Recommendations
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a PRN (as needed) psychotropic medication, Lorazepam, prescribed for a resident with severe cognitive impairment, was addressed in a timely manner. The resident had a BIMS score of 03, indicating severe cognitive impairment, and was admitted with an order for Lorazepam 0.5 mg every four hours as needed for anxiety, without a discontinue date. The medication was administered as documented in the April and May Medication Administration Records. Pharmacy consultation reports in both April and May recommended that the Lorazepam be tapered and discontinued, or that a specific diagnosis and rationale for use be documented, since the medication had been prescribed for more than 14 days. These recommendations were not addressed or signed by the physician. Interviews with the Consultant Pharmacist confirmed that recommendations to add a stop date and review the necessity of the medication were made but not acted upon. The DON acknowledged that Lorazepam is a psychotropic medication and stated that the physician typically reviews pharmacy consults monthly, but the recommendations were not signed because the family did not want the resident to be seen by a psychiatric doctor. The DON also indicated that the order likely originated from the hospital and that the lack of follow-through on the pharmacy's recommendations was due to the family's wishes regarding psychiatric consultation.