Failure to Ensure Safe Use and Monitoring of PRN Psychotropic Medications
Penalty
Summary
The facility failed to ensure the safe use and monitoring of psychotropic medications for five residents who were prescribed PRN lorazepam. Physician orders for these residents did not include required stop dates, resulting in open-ended prescriptions. Additionally, there was no documented clinical justification or rationale in the physician progress notes for the continued use of PRN lorazepam for any of the residents reviewed. The Director of Nursing (DON) and the Administrative Director (ADM) both acknowledged during interviews that the facility was not following regulations regarding PRN psychotropic medications, specifically the requirement for a stop date after 14 days or a documented physician justification for continued use. The review of medical records and medication administration histories for the affected residents showed that lorazepam was ordered on a PRN basis without an end date, and the necessary documentation to justify ongoing use was absent. The DON confirmed these findings during concurrent interviews and record reviews, noting that the orders lacked both stop dates and physician progress notes providing rationale for continued administration. The Medical Director (MD) also acknowledged that the current process involved extending PRN psychotropic orders without documenting a clinical justification in the progress notes, believing that nurse documentation and his signature on the extension sufficed. Facility policies reviewed indicated that chemical restraints, such as psychotropic medications, should only be used when required to treat a resident's symptoms and that the Medical Director is responsible for ensuring compliance with care policies. Despite these policies, the facility's practices did not align with regulatory requirements, as evidenced by the lack of stop dates and clinical justifications for PRN lorazepam orders for the sampled residents.