Failure to Limit and Justify PRN Psychotropic Medication Orders
Penalty
Summary
The facility failed to ensure that residents with orders for psychotropic medications were not subjected to chemical restraints and that PRN (as needed) psychotropic medication orders were limited to 14 days, as required. Multiple residents had PRN psychotropic medication orders that either lacked an end date or extended beyond the 14-day limit without documented physician rationale or evaluation. For example, several residents had ongoing PRN orders for medications such as morphine, hydrocodone-acetaminophen, oxycodone, alprazolam, tramadol, and lorazepam, with no evidence of physician documentation justifying the continuation of these orders past 14 days. Additionally, one resident was prescribed Buspirone three times daily specifically for being combative with staff and excessive pacing, with staff confirming the medication was used for combativeness. This indicates the medication may have been used for staff convenience or discipline, rather than for a medically necessary indication, which constitutes a chemical restraint. Interviews with facility staff, including the DON and LPN, revealed a lack of awareness regarding the regulatory requirement to reassess PRN psychotropic medications after 14 days and to document the rationale for continued use. The facility's own policy stated that PRN orders for psychotropic drugs are limited to 14 days unless the physician documents the rationale for extension, but this was not followed in practice for the residents reviewed.