Failure to Limit PRN Psychotropic Medication Orders to 14 Days
Penalty
Summary
A deficiency was identified when a resident with diagnoses including anxiety, depression, and hypertension was prescribed the antianxiety medication Xanax on a PRN (as needed) basis without a specified duration, contrary to regulatory requirements that limit PRN orders for psychotropic drugs to 14 days unless a physician documents the rationale and duration for extension. The resident's order for Xanax 0.5 mg every 6 hours PRN was written as indefinite, and medication administration records showed the resident received the medication on multiple occasions within a week. During an interview, the DON acknowledged that the PRN order should have been limited to 14 days and was unable to explain why the order was written for an indefinite period. The nursing supervisor, responsible for daily oversight of such orders, confirmed that monitoring was done at random, which contributed to the oversight. Facility policy requires that all medication decisions include appropriate elements of the care process, but this was not followed in this instance.