Failure to Decrease Psychotropic Medication as Ordered
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident's psychotropic medication, Vistaril (hydroxyzine pamoate), was decreased as ordered by the physician. The resident, who had a diagnosis of anxiety disorder and was cognitively intact, had been receiving Vistaril 25 mg at bedtime. A consultant pharmacy recommendation was made to attempt a gradual dose reduction, and the physician accepted this recommendation, modifying the order to decrease the dose to 12.5 mg at bedtime for anxiety. This order was signed and dated by the physician. Despite the physician's order to decrease the medication, review of the Medication Administration Record (MAR) for the following two months showed that the Vistaril dose was not reduced as directed. The medication was only discontinued later, rather than being tapered as ordered. The Director of Nursing confirmed that the dose reduction order was not implemented and acknowledged that the medication should have been decreased according to the physician's instructions. Facility policy required the use of the lowest possible dose of psychotropic medications and gradual dose reductions unless clinically contraindicated, but this was not followed in this instance.