Failure to Document Rationale for Extended PRN Psychotropic Medication Use
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident was free from unnecessary psychotropic drug use by not documenting a rationale for extending a PRN (as needed) Lorazepam order beyond 14 days, as required by facility policy. The resident, who had diagnoses including dementia, depression, and anxiety disorder, was prescribed Lorazepam PRN for anxiety manifested by repetitive verbal outbursts, with an order set for 30 days. The psychiatric follow-up note indicated continued use of Lorazepam to assist with behavior management, but did not provide a documented rationale for extending the PRN order beyond the 14-day policy limit. Interviews with facility staff, including a Licensed Vocational Nurse, Pharmacy Consultant, and the Director of Nursing, confirmed that the Lorazepam order was not limited to 14 days and lacked the required documentation for extension. The facility's policy specified that PRN psychotropic medication orders should be limited to 14 days unless a prescriber documents the rationale for extension and specifies the duration. In this case, there was no psychiatrist documentation justifying the extension prior to the 30-day order, resulting in non-compliance with the facility's policy and procedures.