Failure to Limit PRN Antipsychotic Use and Attempt Gradual Dose Reduction for Psychotropics
Penalty
Summary
The facility failed to ensure compliance with regulations regarding the use of psychotropic medications for two residents. For one resident with vascular dementia and mood disturbances, a PRN order for Haloperidol (an antipsychotic) was issued without a required 14-day limit or documented physician evaluation for continued use. The medication was administered on multiple occasions over several months, and the medical record did not include documentation supporting the extended use or a rationale from a provider. The Director of Nursing confirmed that the order lacked the necessary 14-day duration and supporting documentation for ongoing administration. For another resident with a diagnosis of depression, the facility did not attempt a Gradual Dose Reduction (GDR) for prescribed antidepressant medications, nor did it provide evidence that a GDR was clinically contraindicated. The resident had been receiving the same dosage of two antidepressants for over a year, and the medical record did not reflect any GDR attempts or physician documentation of contraindications. The Director of Nursing acknowledged that no GDR had been attempted and was unable to provide evidence to support that a GDR was considered or contraindicated.