Failure to Ensure Proper Indication for Antipsychotic Medication Use
Penalty
Summary
The facility failed to ensure that a resident had an appropriate indication and diagnosis for the use of an antipsychotic medication, specifically Seroquel (Quetiapine Fumarate). The resident in question was admitted with multiple diagnoses, including cerebral infarction, hemiplegia, aphasia, benign neoplasm of cerebral meninges, adult failure to thrive, and vascular dementia with mood disturbance and anxiety. Physician orders for Seroquel were present, and the care plan referenced its use for dementia with behavioral disturbances. However, the quarterly MDS assessment did not indicate potential indicators of psychosis, and staff interviews revealed that the resident did not exhibit behavioral disturbances or symptoms such as yelling, hitting, or pulling at medical devices. Observations showed the resident was largely non-responsive, unable to move extremities, and required significant assistance with care. A pharmacy review noted that the resident lacked an allowable diagnosis to support the use of Seroquel, and the provider subsequently documented indications such as hiccups and nausea associated with cancer, though staff had not observed these symptoms. Orders for Seroquel were updated to reflect these indications, but staff interviews and observations did not confirm the presence of behavioral disturbances, hiccups, or nausea. The medication continued to be reordered upon each readmission without clear evidence of a supporting diagnosis or observed need, leading to the deficiency related to the use of unnecessary psychotropic medication as a potential chemical restraint.