Failure to Document Monthly Medication Regimen Reviews by Pharmacist
Penalty
Summary
The facility failed to provide documentation that a licensed pharmacist performed monthly medication regimen reviews (MRR) for two of three sampled residents. According to facility policy, a consultant pharmacist is required to complete a drug regimen review for each resident at least monthly, with any irregularities reported. For one resident with diagnoses including depression, chronic pain due to trauma, and dementia, and who required psychotropic medication, there was no documentation of pharmacy review for several consecutive months. Similarly, another resident with intellectual disabilities, urinary incontinence, and colostomy status, also requiring psychotropic medication, lacked documented pharmacy review for multiple months. Staff interviews confirmed the absence of required MRR documentation for both residents during the specified months. The Nursing Home Administrator also acknowledged that the facility could not provide evidence of monthly medication regimen reviews as required by policy and state regulations. The deficiency was identified through review of facility policy, clinical records, and staff interviews.