Failure to Respond to and Document Pharmacy Recommendations for Medication Management
Penalty
Summary
The facility failed to ensure timely and appropriate responses to pharmacy recommendations for multiple residents, as required by policy and procedure. For one resident with diagnoses including cerebral palsy, diabetes, epilepsy, depression, and anxiety, the physician did not address a pharmacist's recommendation for a gradual dose reduction (GDR) of antipsychotics, failed to implement accepted recommendations to taper Metoclopramide and decrease Pantoprazole, and declined recommendations to discontinue sliding scale insulin and reevaluate duplicate topical therapies without providing a rationale. These failures were confirmed by the DON, who verified the lack of physician response, missing orders, and absent rationales in the medical record or pharmacy forms. Another resident with dementia and depression had pharmacy recommendations for GDRs of Abilify and Bupropion; the physician declined one without providing a rationale and did not address the other. A third resident with depression, bipolar disorder, and chronic constipation had pharmacy recommendations for GDRs of Aripiprazole and discontinuation of famotidine, which the physician declined, citing prior failed attempts, but there was no documentation that such attempts had occurred. These deficiencies were identified through staff interviews and record reviews, affecting three of five residents reviewed for unnecessary medications.