Failure to Limit PRN Psychotropic Medication Orders to 14 Days or Provide Justification
Penalty
Summary
The facility failed to ensure that as-needed (PRN) psychotropic medications were limited to 14 days or extended with a specific date and supporting rationale from the medical provider for two residents. For one resident with diagnoses including cancer, diabetes, arthritis, and malnutrition, the medication administration record showed an ongoing order for Prochlorperazine Maleate, an antipsychotic often used for nausea and vomiting, without a stop date or documented rationale for continued use beyond 14 days. This omission was consistent across several months of medication records. Interviews with nursing staff revealed a lack of awareness regarding the requirement for a stop date on such orders, and the facility's policy did not address the 14-day limitation or the need for provider evaluation for continued PRN psychotropic use. Another resident, with a history of Alzheimer's, dementia, anxiety, and other chronic conditions, had an active order for PRN lorazepam for anxiety that also lacked a 14-day stop date. Medication records indicated frequent administration of lorazepam over several weeks. Observations documented the resident repeatedly calling out for help, with staff responding to needs but the behavior persisting. Interviews with staff confirmed regular administration of PRN lorazepam and acknowledged the absence of a required stop date or provider justification for extended use. The facility's policy on psychotherapeutic medications required documentation of diagnosis, consent, and assessment prior to administration but did not specify requirements for PRN psychotropic medication duration, provider evaluation, or clear parameters for use. Both the director of nursing and consultant pharmacist confirmed that the orders should have included a stop date or provider justification, but these were not present in the reviewed cases.