Lack of Clinical Rationale for Continued PRN Lorazepam Use
Penalty
Summary
The facility failed to ensure that a clinician documented a clinical rationale for the continued use of a PRN (as needed) psychotropic medication, specifically Lorazepam, for a resident with diagnoses including depression, psychotic disorder with delusions, pain, weakness, anxiety, and Alzheimer's disease. Multiple verbal orders for Lorazepam 0.5 mg every eight hours as needed for anxiety were confirmed and renewed over several months, but none of the orders included a documented clinical rationale for the ongoing use of the PRN medication. Additionally, a facility form regarding psychotropic medication gradual dose reduction attempts indicated that a dose reduction was not possible, but the required section for clinical rationale was left blank and only signed by the physician. During an interview, the DON acknowledged that the facility had implemented a process for providers to write new orders for PRN medications that were expiring but was unaware that a clinical rationale was required for the continued use of PRN psychotropic medications. Facility policy stated that PRN orders for psychotropic medications beyond 14 days required practitioner documentation of the rationale for the extended order, which was not followed in this case.