Failure to Use Person-Centered Interventions Before Administering Psychotropic Medications
Penalty
Summary
The facility failed to implement person-centered behavioral interventions and attempt less restrictive alternatives prior to administering as-needed psychotropic medications for a resident with severe cognitive impairment and multiple neuropsychiatric diagnoses. The resident was admitted with frontotemporal dementia, agitation, depression, and anxiety, and was prescribed several psychotropic medications, including clonazepam, escitalopram, haloperidol, and hydroxyzine, both on a scheduled and as-needed basis. The care plan included interventions such as allowing the resident to express feelings, encouraging participation in activities, and providing reassurance, but documentation showed these interventions were inconsistently implemented or not attempted prior to medication administration. Medication administration records indicated frequent use of as-needed psychotropic medications, including haloperidol injections and oral tablets, as well as clonazepam and hydroxyzine, often in response to behaviors such as restlessness, agitation, and combativeness. Progress notes documented that non-pharmacological interventions were either ineffective or not attempted before resorting to medication. Staff interviews revealed a lack of awareness of specific behavioral interventions for the resident, with some staff improvising activities like giving the resident a pillowcase to fiddle with. The care plan and behavior tracking records were incomplete, with several shifts lacking documentation of any interventions attempted. Further, the facility did not have policies regarding the use of psychotropic medications or chemical restraints, and there was no systematic monitoring or documentation of side effects for medications with black box warnings. The psychiatric nurse practitioner and physician confirmed that the as-needed psychotropic medication orders were continued from a previous setting, and that behavioral interventions should have been prioritized and documented before medication use. The lack of consistent, person-centered behavioral interventions and documentation, combined with the frequent use of psychotropic medications, led to the deficiency.