Failure to Attempt Gradual Dose Reduction of Psychotropic Medication
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary psychotropic medications, specifically by not attempting a gradual dose reduction (GDR) of Risperidone or documenting a clinical contraindication for not doing so. The resident, who was admitted with diagnoses including dementia and unspecified psychosis, had severe cognitive impairment and was prescribed Risperidone 0.25 mg twice daily for agitation since admission. Medical records and medication administration records confirmed continuous administration of Risperidone without any documented evaluation for GDR or clinical rationale for its ongoing use at the same dose. Physician and nurse practitioner notes over several months did not indicate any assessment for GDR or provide a clinical justification for maintaining the current Risperidone regimen. During an interview, the physician acknowledged reliance on the consultant psychiatric nurse practitioner for recommendations but admitted that neither he nor his nurse practitioner had evaluated or documented the need for continued Risperidone use or considered a GDR. This lack of evaluation and documentation was inconsistent with the facility's policy on psychotropic medication management.