Deficient Use of Antipsychotic Medications Without CMS-Approved Indications
Penalty
Summary
Surveyors identified that three residents were administered antipsychotic medications without a Centers for Medicare and Medicaid Services (CMS) appropriate indication for use. The records for these residents showed diagnoses such as dementia, anxiety, and psychosis, but lacked sufficient documentation of unsuccessful nonpharmacological interventions and clear risk versus benefit statements for the continued use of antipsychotic medications. For example, one resident received Seroquel for anxiety and senile degeneration of the brain, but the electronic medical record did not include a physician's rationale or documentation of attempted nonpharmacological symptom management prior to medication use. Another resident with dementia and psychosis was prescribed Zyprexa for hallucinations and anxiety. Although the care plan and pharmacy consultant recommended gradual dose reduction and required clinical rationale for continued use, the orders and documentation did not consistently provide FDA-approved indications for antipsychotic use in dementia patients. The facility's own policies required regular medication reviews, documentation of side effects, and attempts at dose reduction, but these were not always supported by the clinical documentation in the residents' records. A third resident with dementia, psychosis, and congestive heart failure was also administered Seroquel for anxiety-related behaviors. Despite multiple attempts at gradual dose reduction, the medication was restarted after behavioral symptoms re-emerged, but the documentation did not always reflect clear nonpharmacological interventions or a CMS-appropriate indication for antipsychotic use. The facility's policies emphasized the need for proper diagnosis, documentation, and regular review of psychotropic medications, but the survey found that these requirements were not consistently met, resulting in the administration of unnecessary antipsychotic medications.