Failure to Obtain Consent and Coordinate Psychiatric Services for Psychotropic Medication Use
Penalty
Summary
The facility failed to provide medically related social services by not obtaining informed consent from the resident representative prior to changing a resident's psychotropic medication regimen and by not coordinating necessary psychiatric services. The resident in question had diagnoses including dementia, paranoid schizophrenia, and anxiety disorder, and was prescribed Seroquel for management of psychiatric symptoms. Despite the resident's representative being designated as the medical decision maker, there was no documentation that consent was obtained or that the representative was informed prior to a reduction in the Seroquel dose. Progress notes and interviews confirmed that the medication change occurred without the required communication or consent. Additionally, the facility did not ensure ongoing psychiatric oversight for the resident. After a hospitalization and subsequent readmission, there were no documented psychiatry visits or medication reviews by a psychiatric practitioner for several months, despite the resident's complex behavioral health needs and ongoing use of antipsychotic medication. The facility's contracted psychiatrist was not permitted by the family to see the resident, and the psychiatric nurse practitioner was unable to see the resident due to scheduling conflicts with dialysis appointments. Virtual visits were mentioned as a solution, but had not yet been implemented at the time of the survey. Facility policy required social services to obtain informed consent for psychotropic medications and to coordinate psychiatric or counseling services. However, interviews with the DON and social worker confirmed that these responsibilities were not fulfilled. The social worker acknowledged that no conversation occurred with the resident representative regarding the medication change, and the required documentation and coordination of psychiatric services were lacking. This resulted in a failure to provide the necessary medically related social services to help the resident achieve the highest possible quality of life.