Failure to Provide Gradual Dose Reductions and Appropriate Indications for Psychotropic Medications
Penalty
Summary
The facility failed to ensure that residents receiving psychotropic medications were provided with gradual dose reductions (GDR) and behavioral interventions unless clinically contraindicated, as required. For four out of twelve sampled residents, there was no evidence of attempted GDRs for psychotropic medications, and clinical contraindications for not attempting GDRs were not documented. Specifically, residents with diagnoses such as depression, insomnia, anxiety, and dementia were prescribed medications including sertraline, zolpidem, diphenhydramine, quetiapine, mirtazapine, lorazepam, and fluoxetine without appropriate documentation of GDR attempts or clinical justifications for continued use at the current dosages. Additionally, antipsychotic medications such as quetiapine (Seroquel) were administered to residents without appropriate indications for use, such as for agitation or insomnia, rather than for approved psychiatric diagnoses. Interviews with facility staff, including the DON and Nurse Administrator, revealed a lack of clarity and involvement in the GDR process, with reliance on physician documentation and pharmacist reviews, but without consistent evidence of GDRs or clinical contraindications in the residents' records.