Failure to Attempt or Document Gradual Dose Reduction for Psychotropic Medication
Penalty
No penalty information released
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Summary
A deficiency was identified when a resident with a diagnosis of schizophrenia, who was admitted on 11/06/2020, was found to be receiving Risperdal 1mg twice daily without evidence of a gradual dose reduction (GDR) attempt or documentation that a GDR was clinically contraindicated. The resident's most recent MDS assessment indicated intact cognition and ongoing use of antipsychotic medication, yet there was no record of a GDR being attempted. Additionally, a consultant pharmacist had recommended a GDR for Risperdal, but there was no documented response from the physician to this recommendation. The medical record lacked any documentation supporting either a GDR attempt or a clinical reason for not pursuing one.