Failure to Discontinue PRN Psychotropics and Obtain POA Consent for Severely Cognitively Impaired Resident
Penalty
Summary
The facility failed to ensure that a resident’s drug regimen was free from unnecessary drugs by not discontinuing or obtaining an order to continue as needed (PRN) psychotropic medications after the required 14-day period. Additionally, the facility did not obtain proper psychotropic medication consent from the resident’s Power of Attorney (POA), despite the resident having severe cognitive impairment as indicated by a Brief Interview for Mental Status (BIMS) score of 3/15. The resident, who has diagnoses including major depressive disorder, schizophrenia, schizoaffective disorder, and anxiety disorder, was observed to be oriented to person and place but confused about time and situation, and unable to answer most questions. The review of records showed that the resident personally signed consent forms for psychotropic medications, even though the face sheet documented a POA for health and there was no documentation that the POA was notified or provided consent for these medications. The DON acknowledged that there was no documentation of POA notification or consent for the psychotropic medications. Furthermore, PRN psychotropic medication orders were found to be open-ended and not discontinued or renewed after 14 days as required by facility policy and CMS regulations.