Failure to Limit PRN Psychotropic Medication Without Required Documentation
Penalty
Summary
The facility failed to limit the use of an as-needed (PRN) psychotropic medication, specifically lorazepam, to a 14-day duration without the required documentation for continued use for one resident. The resident, who had diagnoses including anxiety disorder and major depressive disorder and was noted to have severe cognitive impairment, received lorazepam on multiple occasions beyond the 14-day PRN limit. The medical record did not contain documentation from the prescribing practitioner justifying the continued use of lorazepam beyond the initial 14-day period, nor was there evidence of monitoring or rationale for the extended use in psychiatric progress notes. The care plan for the resident indicated the use of anti-anxiety medication related to his diagnoses, with interventions to assess anxiety and administer medication per physician order. However, interviews with staff confirmed that PRN psychotropic medications are limited to 14 days unless otherwise documented, and the facility's policy required physician documentation for any extension. Despite this, the resident continued to receive lorazepam without the necessary documentation or justification for its ongoing use.