PRN Psychotropic Medication Order Lacked Required Stop Date
Penalty
Summary
A deficiency occurred when a resident with an anxiety disorder was prescribed lorazepam, including a PRN (as needed) order, without a required time limitation or stop date. The resident was cognitively intact and had an active physician order for lorazepam 0.5 mg to be given twice daily and every 12 hours as needed for anxiety. The PRN order lacked a stop date, which is necessary for reassessment of the continued need for the medication. The care plan noted the use of anti-anxiety medication and the risk for adverse side effects, with an intervention for the Consulting Pharmacist to review psychotropic medications quarterly and as needed for possible changes or reductions. The Medication Administration Records showed that the PRN lorazepam was administered once in July and not at all in August. During a monthly medication review, the Consulting Pharmacist identified the missing stop date and notified the facility, requesting clarification or discontinuation of the order. Interviews with the DON and Administrator revealed that medication orders were reviewed in daily and morning clinical meetings, but the missing stop date for the PRN lorazepam was overlooked due to the way the order was written and not flagged by the system.