Failure to Limit PRN Psychotropic Medication Order to 14 Days
Penalty
Summary
A deficiency occurred when a resident with dementia, depression, and insomnia was prescribed a PRN (as needed) psychotropic medication, Ativan (Lorazepam), without a required 14-day limitation on the order. The facility's policy, consistent with federal regulations, mandates that PRN orders for psychotropic medications must be limited to 14 days unless the prescriber documents a clinical rationale for extending the order and specifies the duration. In this case, the resident's order for PRN Ativan was initiated with no end date and remained active beyond the 14-day period, with no documented justification from the attending physician or prescriber for the extended use. The resident's medical record showed frequent administration of Ativan for restlessness and anxiety, but lacked the necessary documentation to support continued use beyond the initial 14 days. The surveyor confirmed that the order was still active and that the resident continued to receive the medication. Interviews with the DON and RN supervisor revealed that the order was entered without a stop date by a new nurse, and there was no evidence of the required physician documentation to justify the ongoing PRN use.