Failure to Review and Document Physician Response to Pharmacist Medication Recommendations
Penalty
Summary
The facility failed to ensure that consultant pharmacist recommendations regarding drug regimen reviews were reviewed and implemented by the attending physician, or that the physician provided documentation of a rationale for not following the pharmacist's recommendations. This deficiency was identified for three out of seven residents reviewed for unnecessary medications. In each case, the pharmacist had made specific recommendations, such as considering gradual dose reductions (GDR) for psychotropic medications, but there was no evidence in the medical records that the physician responded to or documented a clinical rationale for declining these recommendations. For one resident with a diagnosis of recurrent depressive disorders, the pharmacist recommended a GDR for fluoxetine (Prozac), but the physician did not implement the recommendation or document a reason for not doing so. The medication administration record showed that the resident continued to receive the medication as originally ordered, and the physician response section on the pharmacist's form was left blank. Another resident with depression, seizures, and traumatic brain injury had a recent fall, and the pharmacist noted that the resident's medications could increase fall risk, asking if the physician would like to make any changes and to provide a clinical rationale. The physician only documented that the resident was stable on the medications, without specifically addressing the pharmacist's recommendations or providing a detailed rationale. A third resident with dementia and depressive disorders had multiple psychotropic medications for which GDRs were recommended and declined, but the physician did not document any rationale in the medical record for not following the pharmacist's recommendations.