Failure to Complete Timely AIMS Assessment for Resident on Antipsychotic
Penalty
Summary
The facility failed to complete an Abnormal Involuntary Movement Scale (AIMS) assessment for a resident who was prescribed Zyprexa, an atypical antipsychotic, for mood disorders. The resident had a history of late-onset Alzheimer's disease with behavioral disturbance, dementia with mood disturbances, recurrent major depressive disorder, major neurocognitive disorder due to dementia, generalized anxiety disorder, and primary insomnia. Physician orders indicated the resident was to receive Zyprexa twice daily, and the Minimum Data Set (MDS) confirmed regular antipsychotic use with a clinically contraindicated Gradual Dose Reduction. The last documented AIMS assessment was completed over a year prior, despite recommendations from the Consulting Pharmacist for baseline and six-monthly AIMS assessments due to the risk of extrapyramidal side effects associated with the medication. Interviews with facility staff, including the Consulting Pharmacist, Psychiatric Nurse Practitioner, Physician, Weekend Supervisor, Director of Nursing (DON), and Administrator, confirmed that AIMS assessments were expected every six months for residents on Zyprexa. The Consulting Pharmacist had recommended the assessment in April, but the DON, who was responsible for completing or delegating the task, acknowledged that the assessment was not completed as required. The facility's electronic medical record system was designed to alert staff to due assessments, but the AIMS assessment for this resident was not performed or documented within the recommended timeframe, and no further AIMS assessments were provided for review.