Failure to Administer Antipsychotic Medication and Notify Provider for Resident with Behavioral Health Needs
Penalty
Summary
A resident with diagnoses including anxiety, paranoid schizophrenia, dementia, and depression was readmitted to the facility following a psychiatric hospitalization, with orders to receive Uzedy, an atypical antipsychotic, via subcutaneous injection every 30 days. The medication was not administered as ordered on the scheduled date, and the medication administration record (MAR) indicated it was not given, with a note stating it was unavailable. However, pharmacy records and direct observation confirmed that the medication was present in the facility at the time it was due. The Director of Nursing (DON) confirmed there was no documentation that the physician or nurse practitioner was notified of the missed dose, as required by facility policy. Interviews with nursing staff revealed inconsistent practices regarding medication administration and documentation. One LPN reported not seeing the medication in the cart and did not prepare it in advance, assuming the resident would refuse, and could not confirm if the nurse practitioner was notified of the missed dose. The nurse practitioner stated she was not informed about the missed injection and emphasized the importance of the medication for the resident's stabilization, especially given his refusal of oral medications. The MAR also showed frequent refusals of oral Depakote, with varying documentation of interventions used to encourage acceptance, such as education, encouragement, and attempts to offer medication with food, though not all interventions were consistently documented or reflected in the care plan. The resident's care plans addressing refusal of care and medication did not include all effective interventions known to staff, such as offering snacks or crushing medications with food, despite these being recognized strategies by staff and discussed in interviews. The facility's policies required individualized care planning and prompt notification of the physician when medications were refused or missed, but these procedures were not fully implemented. The lack of administration of the antipsychotic medication, failure to notify the provider, and incomplete care planning and documentation for medication refusals led to the identified deficiency.