Failure to Attempt Gradual Dose Reduction of Psychotropic Medication
Penalty
Summary
A deficiency was identified when a resident with a diagnosis of dementia with psychotic disturbance was maintained on Risperdal (an antipsychotic) for an extended period without a documented attempt at gradual dose reduction (GDR), as required. The resident had been stable, with no acute concerns or documented psychiatric or behavioral issues, and nursing progress notes did not indicate any behaviors that would contraindicate a GDR. Despite this, the resident's Durable Power of Attorney (DPOA) consistently refused attempts at GDR, and the facility did not document any clinical contraindication for not attempting a reduction. Interviews with facility staff confirmed that no GDR had been attempted and that the resident had not exhibited psychotic or hallucinatory episodes. The facility's own policy requires consideration of medication tapering when a resident's condition is stable, and mandates GDR for residents on psychotropic medications unless clinically contraindicated. The lack of documented clinical justification for not attempting a GDR constituted a failure to comply with both facility policy and regulatory requirements.