Lack of Attending Physician Review of Monthly Medication Regimen Reviews
Penalty
Summary
The facility failed to provide evidence that monthly medication regimen reviews (MRR) were reviewed by the attending physician for three residents. For each resident, the clinical records showed that the MRRs were completed and signed by a Certified Registered Nurse Practitioner (CRNP), but there was no documented response or review from the attending physician as required. Specifically, for one resident with dementia, anxiety, and cognitive decline, the MRR did not include the attending physician's response, and the CRNP made decisions regarding gradual dose reduction for multiple psychotropic medications. Another resident with adult failure to thrive, hypertension, and dementia also had an MRR lacking the attending physician's review, with the CRNP making medication discontinuation decisions. A third resident with dementia, anxiety, depression, and Alzheimer's disease similarly had their MRR reviewed and signed by a CRNP, with decisions made about not completing gradual dose reductions for several medications, but without the attending physician's documented involvement. During staff interviews, it was confirmed that the facility did not ensure the attending physician reviewed the MRRs monthly for these residents, and that the reviews were instead conducted by nurse practitioners. This practice was not in accordance with facility policy and regulatory requirements, as the attending physician's review and response were missing from the medical records for all three residents involved.