Antipsychotic Medication Prescribed Without Appropriate Diagnosis
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary medications. Specifically, a resident with Alzheimer's disease and no documented psychosis was prescribed and administered Seroquel, an antipsychotic medication, without an appropriate diagnosis to justify its use. The medication order listed 'agitation' as the indication, but did not include a corresponding diagnosis, and the resident's records did not reflect behaviors such as physical or verbal aggression that would typically warrant antipsychotic therapy. The resident was observed to be calm and unable to answer questions, and her medical history included memory problems and inability to make daily decisions, but not psychosis. Interviews with facility staff revealed that the Assistant Director of Nursing (ADON) entered the Seroquel order without ensuring a proper diagnosis was included, despite being trained to do so. The Psychiatric Nurse Practitioner (NP) stated he diagnosed the resident with unspecified psychosis after several meetings, but acknowledged the order should have specified the diagnosis. The Director of Nursing (DON) confirmed that orders are checked for accuracy and that the diagnosis should have been included. The facility's policy on psychotropic medication use did not address the requirement for a diagnosis to accompany medication orders. Manufacturer information for Seroquel highlighted increased mortality risks for elderly patients with dementia-related psychosis, and the drug is not approved for such use.