Failure to Monitor Target Behaviors for Psychotropic Medication Use
Penalty
Summary
The facility failed to ensure that target behaviors were identified and monitored for a resident who was prescribed psychotropic medications for anxiety related to major depressive disorder. The resident, who was cognitively intact and had diagnoses including acute respiratory failure, Amyotrophic Lateral Sclerosis, and major depressive disorder, was ventilator dependent and received clonazepam via gastrostomy tube. Provider orders indicated the use of clonazepam for anxiety, but there was no documentation or monitoring of specific target behaviors associated with the medication. The care plan noted the potential for adverse drug reactions and included general interventions such as administering medications as ordered and monitoring for adverse reactions, but did not specify or track target behaviors for anxiety. Interviews with nursing staff confirmed that while the resident had a history of anxiety, especially during suctioning and repositioning, there was no ongoing documentation of anxiety-related behaviors or the effectiveness of the psychotropic medication. Staff only documented changes in condition, not daily observations of anxiety or related behaviors. The DON stated that monitoring target behaviors was expected for residents on psychotropic medications to assess medication effectiveness, but acknowledged that this was not being done. Facility policy required identification and monitoring of target behaviors for residents prescribed psychotropic medications, but this was not followed in the resident's case.