Failure to Reassess PRN Psychotropic Medications by Physician
Penalty
Summary
The facility failed to ensure that two residents receiving as-needed (PRN) antianxiety medications were properly assessed by a physician for the continued need of these medications. One resident, with diagnoses including anxiety disorder, COPD, major depressive disorder, and alcohol dependence, had an order for Ativan PRN that was not reviewed or reassessed by a physician since its initiation. Physician visit notes did not document a rationale for continued use, frequency of administration, or effectiveness of the medication. Similarly, another resident with anxiety disorder and moderate cognitive impairment had a PRN order for clonazepam that was not reviewed or reassessed by a physician for several months, with no documentation supporting ongoing need or effectiveness. Pharmacy reviews conducted during this period did not identify the lack of physician reassessment or the absence of end or review dates for the PRN psychotropic medications. Nursing staff interviews confirmed that PRN psychotropic medications should be reassessed every 14 days unless otherwise documented, but this process was not followed. The consulting pharmacist reported reviewing PRN psychotropic medications during monthly reviews but did not notify the provider directly about the need for reassessment, relying on the facility to ensure compliance. No facility policy on PRN psychotropic medication reassessment was provided during the survey.