Consultant Pharmacist Failed to Identify Missing PRN Parameters and Unapproved Antipsychotic Diagnosis
Penalty
Summary
The facility failed to ensure that the Consultant Pharmacist (CP) identified and addressed the lack of specific parameters for the use of as-needed (PRN) opioid and diuretic medications for one resident, and failed to address an unapproved diagnosis for the use of an antipsychotic medication for another resident. For the first resident, the medical record showed multiple diagnoses including chronic pain, polyneuropathy, and major depressive disorder. The resident received PRN oxycodone and bumetanide, but the physician's orders lacked specific parameters for administration, such as pain level or type, and guidelines for edema. The Medication Administration Records indicated frequent administration of these medications, and both nursing staff and administrative staff confirmed that the orders lacked necessary parameters. The monthly medication regimen reviews conducted by the CP did not include recommendations or clarifications regarding these missing parameters. For the second resident, the medical record documented diagnoses of dementia, major depressive disorder, and Parkinson's disease. The resident received Seroquel, an antipsychotic, with the physician's order citing major depressive disorder and anxiety as the indications. However, the care plan did not specify targeted behaviors for the use of Seroquel, and the diagnosis for its use was changed by nursing staff without proper documentation or physician input. The CP did not address the appropriateness of the diagnosis for the antipsychotic during monthly reviews. Administrative staff acknowledged that the diagnosis for Seroquel was not appropriately documented and that the CP had not raised this issue. Facility policies required pharmacy services to be provided in accordance with state and federal regulations, including clear and accurate physician orders for antipsychotic medications and regular review of medication appropriateness by the CP. Despite these policies, the CP did not identify or report the lack of specific parameters for PRN medications or the inappropriate diagnosis for antipsychotic use, resulting in deficiencies in medication management and oversight.