Antipsychotic Medication Administered Without Appropriate Diagnosis
Penalty
Summary
A deficiency was identified when a resident was administered Seroquel (quetiapine), an antipsychotic medication, without an appropriate or documented diagnosis to support its use. The resident had diagnoses of Parkinson's disease, dementia without behavioral or mood disturbances, altered mental status, and depression. The care plan noted altered behaviors and hallucinations, but the Minimum Data Set assessment indicated severe cognitive impairment with no behaviors or psychiatric/mood disorders. Despite this, Seroquel was prescribed and administered over several months, with dosage adjustments made for reported anxiety and behaviors, but without any formal diagnosis documented in the medical record. Interviews with facility staff revealed that the Nurse Practitioner ordered Seroquel based on a hospice recommendation, acknowledging it was used off-label and not in accordance with FDA-approved indications. The DON was unaware that the medication order lacked an appropriate diagnosis and did not recognize that the documented reasons for use were not FDA-approved indications. Facility policy required psychotropic medications to be prescribed only with appropriate diagnosis or supporting documentation, which was not followed in this case.