Failure to Ensure Physician Oversight After Repeated Medication Refusals
Penalty
Summary
A deficiency was identified when a resident with diagnoses including dementia, behavioral issues, and homelessness repeatedly refused their prescribed antipsychotic medication, Quetiapine (Seroquel). Despite these refusals, there was no documented evidence that the psychiatric nurse practitioner, who prescribed the medication, implemented an intervention plan or notified the primary care physician about the ongoing refusals. The resident's medication administration records showed a significant number of missed doses over several months, with refusals increasing over time. The facility's policies required that a physician, physician assistant, nurse practitioner, or clinical nurse specialist provide orders for the resident's immediate care and needs, and that the physician take an active role in supervising resident care. However, the psychiatric progress notes only indicated that the resident should continue the current medication regimen, with no mention of the refusals or any plan to address them. The psychiatric nurse practitioner acknowledged being aware of the resident's inconsistent medication intake but did not know the exact number of refusals and did not take further action. Interviews revealed that the primary care physician was unaware of the extent of the missed doses and stated that the medication would not be effective with so many missed doses, potentially impacting the resident's judgment. The psychiatric nurse practitioner confirmed that no changes were made to the medication regimen, citing the resident's right to refuse medication. The lack of communication and intervention regarding the resident's repeated medication refusals led to the finding that the facility did not ensure the resident was under appropriate medical supervision as required by regulation.