Failure to Specify Duration and Rationale for PRN Antianxiety Medication
Penalty
Summary
The facility failed to ensure that a resident's as-needed (PRN) antianxiety medication, lorazepam (Ativan), had a 14-day stop date or a specified duration with a documented physician rationale for ongoing use. The resident in question had diagnoses including cerebral infarction, Alzheimer's disease, and dysphagia, and was noted to have severely impaired cognition, requiring extensive assistance with activities of daily living. The resident's care plan indicated the use of Ativan for end-of-life restlessness, and the physician's order directed staff to administer lorazepam 1 mg as needed for agitation, but did not include a stop date or specified duration. Review of the electronic health record revealed no evidence of a physician's rationale for the extended use of PRN lorazepam. Staff confirmed that the medication was administered without the required 14-day stop date or documentation supporting continued use. The facility's policy required that PRN psychotropic medications not be renewed beyond 14 days without a healthcare practitioner's evaluation and documented rationale, and that the duration be indicated in the order. This policy was not followed in this case.