Failure to Monitor Effectiveness and Adverse Effects of Psychotropic Medications
Penalty
Summary
The facility failed to ensure that residents receiving psychotropic medications, specifically antidepressants, were monitored for effectiveness and adverse consequences as required. Multiple residents with diagnoses such as depression, dementia, schizoaffective disorder, and anxiety were prescribed various antidepressant medications, including Citalopram, Trazodone, Effexor, Sertraline, Bupropion, and Duloxetine. Despite care plans and physician orders indicating the need for monitoring, there was no documentation in nurse's notes or Medication Administration Records (MARs) that such monitoring occurred for these residents over extended periods. For example, one resident with severe cognitive impairment and diagnoses of Parkinson's disease and dementia was prescribed Citalopram and Trazodone, with care plans requiring monitoring every shift. However, there was no evidence in the medical record or MARs that monitoring for effectiveness or adverse effects was performed. Similar findings were noted for other residents with major depressive disorder, schizoaffective disorder, and anxiety, all of whom had orders and care plans specifying the need for monitoring, but lacked corresponding documentation. Interviews with the DON and the Medical Director confirmed that nursing staff were expected to monitor and document the effectiveness and adverse effects of psychotropic medications, but this was not being done. Additionally, the facility did not have a specific policy for psychotropic medication use, instead relying on an antipsychotic medication policy, which did not address the broader category of psychotropic drugs. This deficiency affected all five residents reviewed for unnecessary medications, out of a total of 40 residents receiving psychotropic medications in the facility.