Failure to Obtain Informed Consent and IDT Review Before Initiating Psychotropic Medication
Penalty
Summary
The facility failed to obtain written informed consent and conduct an interdisciplinary team (IDT) meeting prior to initiating psychotropic medications for a resident diagnosed with dementia, bipolar disorder, and schizophrenia. The resident was determined to lack capacity to make decisions, as documented in the history and physical and the Minimum Data Assessment, which indicated severely impaired cognitive skills and total dependence on staff for daily care. Despite this, the resident was started on Depakote and risperidone based on physician telephone orders, and these medications were administered as documented in the medication administration records. During review, the Director of Nursing confirmed that informed consent forms for the psychotropic medications were not signed by the IDT and that no IDT meeting minutes were completed before the medications were initiated. The facility's policy required an IDT review and a bioethics meeting involving the resident's physician, another physician, and the IDT prior to administering psychoactive medications to residents lacking capacity, except in emergencies. These steps were not followed in this case.