Failure to Ensure Appropriate Indication for Antipsychotic Medication
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary medications, specifically regarding the use of Seroquel (an antipsychotic). Record review showed that the resident, an older female with diagnoses of major depressive disorder, bipolar disorder, and adjustment insomnia, had physician orders for Seroquel to treat all three conditions, as well as Cymbalta for major depressive disorder. The orders did not specify an appropriate diagnosis for the use of Seroquel, and the care plan identified her as being at high risk for side effects from both antidepressant and antipsychotic medications. The Minimum Data Set (MDS) confirmed the resident was taking both an antipsychotic and an antidepressant and had moderately impaired cognition. During interviews, the DON stated she was unaware that the resident had multiple diagnoses listed for Seroquel and acknowledged that a resident could receive a medication for the wrong indication. She explained that nurses are responsible for verifying the correct diagnosis with the physician, and that she and the ADONs conduct random chart reviews. The facility's policy on psychotropic medications requires that such drugs only be given when necessary to treat a specific, documented condition and that the medication's benefit be demonstrated through monitoring and documentation, which was not followed in this case.