Failure to Monitor Psychotropic Medication Use and Necessity
Penalty
Summary
The facility failed to ensure adequate behavioral monitoring and evaluation of psychotropic medication necessity for a resident with multiple complex diagnoses, including severe dementia with agitation and neurocognitive disorder with Lewy bodies. Upon review, the resident had physician orders for Seroquel, an antipsychotic medication, without any accompanying instructions for behavioral monitoring. There were no orders or documentation specifying behavioral monitoring, and the Medication Administration Record did not reflect any monitoring for effectiveness or adverse consequences related to the use of Seroquel. Progress notes from the period reviewed did not document any negative behaviors, and staff interviews confirmed the absence of recent behavioral issues. Further, the physician acknowledged that the Seroquel prescription was continued from a previous care setting and not based on recent behaviors, with no recent reports of behavioral issues or attempts at gradual dose reduction. Observations of the resident showed no negative behaviors, and staff interviews corroborated a decline in the resident's condition but no current behavioral concerns. The FDA guidelines for Seroquel indicate it is not approved for elderly patients with dementia-related psychosis, and the medication carries a black box warning for this population. Despite this, the facility did not implement or document behavioral monitoring to justify the ongoing use of the antipsychotic medication.