Failure to Limit PRN Psychotropic Medication Orders and Document Non-Pharmacological Interventions
Penalty
Summary
The facility failed to comply with federal regulations regarding the use of psychotropic medications, specifically by allowing as-needed (prn) orders for anti-psychotic and anti-anxiety medications to extend beyond the required 14-day limit without appropriate face-to-face evaluations and clinical rationales. In one case, a resident with schizo-affective disorder, bipolar disorder, anxiety, depression, and insomnia had a prn order for Zyprexa (an anti-psychotic) to be administered intramuscularly for agitation, with the order set for 180 days. Despite pharmacy recommendations referencing the 14-day regulatory limit and the need for prescriber evaluation, the psychiatrist continued to order the medication for extended periods. The medication was administered 12 times over five months, and in 10 of those instances, there was no documentation that non-pharmacological interventions (NPIs) were attempted prior to administration. Another resident, admitted with diagnoses including a sacrum fracture, stomach cancer, neuropathy, anemia, hypertension, and anxiety, and who was on hospice care, had prn orders for Xanax and lorazepam for anxiety. These orders did not include end dates, failing to specify the duration of use as required by regulation. The DON confirmed that these prn orders lacked the necessary time limitations. The facility's policy stated that prn orders for anti-psychotic medications should be limited to 14 days and not renewed without an in-person evaluation by the prescriber. However, the facility did not adhere to this policy in the cases reviewed, resulting in extended prn orders and a lack of documented attempts at NPIs prior to administering anti-psychotic medications.