Failure to Limit PRN Psychotropic Medication Use Without Timely Physician Review
Penalty
Summary
The facility failed to ensure that PRN (as needed) psychotropic medications, specifically Lorazepam (Ativan), did not extend beyond 14 days without a documented rationale and duration of use for three residents. For one resident admitted to hospice, an open-ended order for Ativan was initiated by hospice services without a stop date or specified duration, and there was no evidence of regular re-evaluation by a physician or practitioner. The consultant pharmacist indicated that weekly evaluations typically occur for hospice residents, but documentation supporting this was not found in the record. The Assistant Director of Nursing confirmed that the Ativan order was initiated by hospice and remained open-ended, with no recent physician or nurse practitioner evaluation since admission. Two additional residents with histories of dementia, psychosis, and other mental health conditions also had open-ended PRN Lorazepam orders without discontinue dates or documented rationales for continued use. Medication administration records showed that staff administered these medications as needed, but there was no evidence of physician review or justification for extending the orders beyond the recommended 14-day period. These findings were based on record reviews and staff interviews.