Failure to Specify Stop-Date for PRN Anti-Anxiety Medication
Penalty
Summary
The facility failed to ensure that a stop-date was included for a PRN (as needed) anti-anxiety medication order for one resident. The resident, who had multiple diagnoses including heart disease, malnutrition, adjustment disorder, anxiety disorder, falls, delirium, depression, and dementia with behaviors, had a physician order for Ativan 0.5 mg to be given every four hours as needed. This order, originating in December, was re-ordered in March and June with the same instructions and no defined duration for use. Monthly medication regimen reviews by the facility's pharmacist in January, February, and March each recommended that a duration of use be specified for the PRN Ativan order. The attending physician signed these reviews and indicated a specific duration (either 14 or 30 days) on the forms, but the original order in the system was never updated to reflect these durations. During the survey, it was discovered that the monthly medication regimen reviews for April and May could not be located by the facility's Director of Nursing. When questioned, the Director of Nursing stated that if the physician signed the form and specified a duration, it was the physician's responsibility to update the order in the computer system. Additionally, a review of the facility's Drug Regimen Review policy revealed that it did not address the process for changing orders based on the pharmacist's recommendations and the physician's responses. As a result, the resident's PRN Ativan order remained active without a specified stop-date, contrary to recommendations and documentation.