Failure to Prevent Unnecessary Psychotropic Medication Use and Inadequate Monitoring
Penalty
Summary
The facility failed to prevent the concurrent use of two antidepressant medications, Celexa and Wellbutrin, for a resident diagnosed with major depressive disorder. There was no documented clinical rationale for using both medications simultaneously, and the care plan did not specify Wellbutrin as a targeted intervention. Additionally, staff did not monitor the use of Wellbutrin for adverse effects in the Medication Administration Record (MAR), and psychiatric progress notes lacked any discussion or justification for the dual therapy. Another resident with schizoaffective disorder was prescribed two antipsychotic medications, Seroquel and Abilify, at the same time, again without a documented clinical rationale. The psychiatric nurse practitioner confirmed there was no clinical justification for this duplicate therapy, other than historical use, and acknowledged that such practice is uncommon without dose optimization. The facility's documentation and care planning did not address the need for or appropriateness of using both antipsychotics together. For a third resident with generalized anxiety disorder, the facility did not ensure that the behavior manifestations for the use of buspirone and clonazepam were specific and measurable. The care plan and physician's orders described the behaviors in vague terms, such as "feeling of anxiety" and "restlessness as evidenced by negative vocalizations," which staff and quality assurance personnel agreed were not sufficiently specific or person-centered. This lack of specificity hindered proper monitoring of the medications' effectiveness and appropriateness, as well as the ability to track adverse effects.