Delayed Response to Pharmacy Recommendations for Medication Regimen Review
Penalty
Summary
The facility failed to timely respond to pharmacy recommendations for two residents regarding unnecessary medications, as identified through observation, interview, and record review. For one resident with chronic respiratory failure, major depressive disorder, adjustment disorder, anxiety, and GERD, the pharmacist recommended reevaluating the use of both Eliquis and low-dose aspirin due to her low hemoglobin, and the practitioner agreed to discuss and adjust the treatment. However, there was a delay in discontinuing aspirin, and after a hospital readmission, aspirin was restarted and continued for several months before being discontinued again. Additionally, the pharmacist recommended reducing the dose of famotidine due to potential adverse effects, but the practitioner disagreed, citing a previous unsuccessful gradual dose reduction, which was later confirmed by the DON to have not been completed or documented. For another resident with diabetes, anxiety disorder, chronic kidney disease, hypertension, bipolar disorder, and dementia, the pharmacist recommended increasing the Humalog dose and discontinuing sliding scale insulin, as prolonged use of sliding scale insulin is not recommended. The practitioner agreed to discuss and adjust the insulin regimen, but the order was not updated for two months. Documentation did not reflect the intended changes, and the practitioner later stated that after discussing with the resident, it was decided to maintain the current insulin regimen, but this was not documented in the progress notes or medication review. The facility's policy required practitioners to review and sign off on pharmacist recommendations within 14 days but did not address the timeliness of implementing agreed-upon changes. In both cases, there was either a delay or lack of documentation in acting upon pharmacy recommendations that were accepted by practitioners, resulting in continued administration of medications that were recommended for change or discontinuation.