Failure to Identify and Report Missing Stop Date for PRN Antianxiety Medication
Penalty
Summary
The facility failed to ensure that the Consultant Pharmacist identified and reported the absence of a 14-day stop date or specified duration for a resident's as-needed (PRN) antianxiety medication, as required by facility policy and federal regulations. The resident in question had diagnoses of anxiety, dementia, and major depressive disorder, with severely impaired cognition and required extensive assistance with activities of daily living. The physician's order for Ativan (lorazepam) cream, to be administered every six hours as needed for anxiety or aggression, did not include a stop date or documented rationale for continued use beyond 14 days. The resident's electronic medical record also lacked evidence of a specified duration or physician justification for the ongoing PRN use of lorazepam. During the monthly drug regimen review, the Consultant Pharmacist did not identify or report the missing stop date or rationale for the extended use of the PRN antianxiety medication to the Director of Nursing, medical director, or physician. Administrative staff confirmed that the facility did not obtain the required 14-day stop date or appropriate rationale for continued use, and that the pharmacist's monthly reviews did not include recommendations regarding this issue. Facility policies required that antipsychotic and antianxiety medications be prescribed for the shortest effective duration and reassessed periodically, but these procedures were not followed in this case.