Lack of Physician Rationale for Extended Psychotropic Medication Use
Penalty
Summary
A deficiency was identified when the facility failed to ensure that the physician or prescribing practitioner documented a rationale in the medical record for the use of a psychotropic medication for a period of 180 days. Specifically, a resident with mild cognitive deficits and multiple diagnoses, including traumatic brain injury and hemiplegia, had a physician order for Lorazepam (Ativan) 1 mg to be given every 12 hours as needed. The consultant pharmacist made recommendations to the physician on two occasions to either specify the duration for the PRN order or discontinue the medication, in accordance with federal guidelines. The physician responded by agreeing to continue the PRN use of Lorazepam for 180 days, stating that the benefit outweighed the risk, but did not provide a specific rationale in the resident's medical record or on the recommendation form. Further review of the resident's physician progress notes and psychiatric visit notes revealed no documentation of a rationale for the continued use of Lorazepam. Interviews with facility staff, including the DON, pharmacist, and regional clinical RN, confirmed that the physician did not document the required rationale in the medical record or on the pharmacy recommendation forms. Additionally, psychiatric notes did not reference Lorazepam as a prescribed medication for the resident. The facility's policy required the consultant pharmacist to document findings and recommendations and for the physician to provide a pertinent response, which was not met in this case.