Failure to Document Rationale and Gradual Dose Reduction for Psychotropic Medications
Penalty
Summary
The facility failed to ensure that as-needed (PRN) antipsychotic medications were limited to a 14-day period and that clinical rationale was documented for continuation beyond this timeframe. For two residents, there was no evidence in the medical records to support the ongoing use of PRN psychotropic medications past 14 days, nor was there documentation of a gradual dose reduction (GDR) or appropriate indication for use. Pharmacy reconciliation reports repeatedly requested clinical rationale and GDRs, but the facility did not respond or provide the required documentation. One resident, who was moderately cognitively impaired and had multiple diagnoses including anemia, heart failure, renal insufficiency, diabetes, hyperlipidemia, and anxiety, was prescribed alprazolam PRN with no documented rationale for use beyond 14 days. Another resident, who was severely cognitively impaired with diagnoses including peripheral vascular disease, arthritis, Alzheimer's, and anxiety, was prescribed multiple psychotropic medications, including haloperidol and olanzapine, with no clinical rationale for their continued use past 14 days. Additionally, there was no evidence of a GDR for the resident's antidepressant, and morphine was prescribed with an inappropriate indication of dementia. The consulting pharmacist confirmed that the required clinical rationales and GDRs were missing from the medical records and that multiple requests for this information had gone unanswered. The DON also confirmed the lack of documentation and was unsure who was responsible for completing pharmacy reviews, as the previous DON had left unexpectedly. Facility policy required documentation of rationale for extended psychotropic use and GDRs, but these requirements were not met for the residents reviewed.