Failure to Ensure Approved Diagnosis for Antipsychotic Medication Use
Penalty
Summary
The facility failed to ensure that a resident received an approved diagnosis for the use of Risperidone, an antipsychotic medication, as required by policy and regulation. The resident had documented diagnoses of Lewy body dementia, anxiety disorder, recurrent major depressive disorder, and impulse disorder. The resident's Minimum Data Set (MDS) indicated moderately impaired cognition, no behaviors or mood issues, and a need for maximum staff assistance with activities of daily living. Despite this, the resident was administered Risperidone for Lewy Body Dementia with behavioral disturbance, but there was no approved diagnosis or physician's rationale documented for the use of this medication for that specific condition. The care plan directed staff to administer medications as ordered, obtain labs, and provide gradual dose reductions as recommended by the pharmacist, with monthly reviews by the consultant pharmacist and physician. The consultant pharmacist requested the diagnosis for Risperidone, and the physician responded that it was for Lewy Body Dementia with behavioral disturbance. However, administrative staff later verified that this was an unapproved diagnosis and that the physician had not provided a rationale for the unapproved use. The facility's policy required a qualifying diagnosis and target behaviors for each psychotropic drug, as well as physician certification of necessity, which was not met in this case.