Failure to Limit and Document PRN Psychotropic Medication Use
Penalty
Summary
The facility failed to comply with federal regulations regarding the use of PRN (as needed) psychotropic medications, specifically antipsychotics and antianxiety drugs, for a resident with multiple complex medical conditions, including Alzheimer's disease, anxiety disorder, and depression. The clinical record review revealed that PRN antipsychotic medications such as Haloperidol and Zyprexa were ordered and administered for periods exceeding the 14-day federal limit without documented physician assessments or clinical rationales for the extended use. Orders for these medications were repeatedly renewed for 30 days or longer, and pharmacy consulting reports consistently recommended reassessment and adherence to the 14-day limitation, but these recommendations were not followed with appropriate documentation or evaluation by the prescribing physician or practitioner. Additionally, the facility failed to document behavioral symptoms or the use of nonpharmacological interventions prior to administering PRN antianxiety medications, such as Ativan, as required by both facility policy and federal regulation. The medication administration records showed frequent use of these medications over several months, yet there was a lack of corresponding documentation of behaviors or attempts at alternative interventions before medication was given. The Director of Nursing confirmed that staff were expected to document behaviors and nonpharmacological interventions prior to administering PRN psychotropic medications, but this was not consistently done. The facility's own policy required that PRN orders for psychotropic medications be limited to 14 days unless a clinical rationale for extension was documented, and that nonpharmacological approaches be attempted first. Despite this, the clinical records lacked evidence of physician assessments, clinical rationales for extended PRN use, and documentation of behavioral monitoring or nonpharmacological interventions. These failures were observed for one resident reviewed for unnecessary medications, in a facility with a census of 47 residents.