Failure to Obtain Stop Date for PRN Antianxiety Medication
Penalty
Summary
The facility failed to obtain a stop date for an as-needed (PRN) antianxiety medication, lorazepam, prescribed to a resident with multiple complex medical conditions, including severe protein-calorie malnutrition, chronic kidney disease, major depressive disorder, chronic ulcer, paralytic syndrome, anemia, peripheral vascular disease, diabetes mellitus, and paraplegia. The resident's care plan noted high-risk use of lorazepam and opioids, with warnings about potential for profound sedation, respiratory depression, coma, and death. The physician's order for lorazepam directed administration every four hours as needed for agitation, anxiety, or shortness of air, but did not include a stop or discontinue date. Review of the resident's electronic medical record and interviews with facility staff confirmed that the PRN lorazepam order was indefinite and lacked a required stop date. Facility policy and CMS regulations require that each resident's drug regimen be free from unnecessary drugs, including those used for excessive duration. Staff acknowledged the omission, and documentation showed that the resident had experienced episodes of minimal responsiveness, leading to medications being held due to inability to safely swallow. The absence of a stop date for the PRN lorazepam order constituted a failure to ensure the resident's drug regimen was free from unnecessary drugs.