Lack of Rationale for Not Reducing Psychotropic Medication
Penalty
Summary
The facility failed to provide a rationale for not conducting a Gradual Dose Reduction (GDR) of a psychotropic medication for one resident. Record review showed that the resident, who was cognitively intact with a BIMS score of 13/15, was prescribed risperidone for bipolar disorder. A pharmacy review recommended a reduction in the medication dosage, but the primary physician disagreed with this recommendation and did not document a rationale for the decision. Further review of the facility's pharmacy policy indicated that when a physician rejects a pharmacy recommendation, an explanation must be provided. In this case, the Director of Nursing confirmed that no rationale was documented by the physician for not implementing the GDR. The facility did not follow its own policy requiring documentation of the physician's reasoning when declining a pharmacy recommendation.