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F0605
D

Failure to Attempt Non-Pharmacological Interventions Before PRN Psychotropic Medication

Erie, Pennsylvania Survey Completed on 11-19-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide evidence that non-pharmacological interventions were attempted prior to administering a PRN psychotropic medication to a resident. According to facility policy, non-pharmacological approaches should be used to minimize the need for medications unless contraindicated. Review of the clinical record for a resident with diagnoses including diabetes, anxiety, and high blood pressure showed that the resident had physician orders for Lorazepam, both as a routine and PRN medication for anxiety. The Medication Administration Record indicated that PRN Lorazepam was administered six times over several days. Documentation review revealed no evidence that non-pharmacological interventions were attempted before each administration of the PRN Lorazepam. This lack of documentation was confirmed by the Nursing Home Administrator during an interview, who acknowledged that the facility did not have evidence of such interventions being tried prior to each use of the PRN anti-anxiety medication for the resident.

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