Failure to Discontinue Unnecessary Medications Resulting in Resident Decline
Penalty
Summary
The facility failed to ensure that a resident’s drug regimen was free from unnecessary medications, resulting in a significant decline in the resident’s functional status. The resident, who was severely cognitively impaired and initially independent with mobility, was administered multiple medications including valproic acid, lacosamide, olanzapine, melatonin, and paroxetine. Despite a neurologist’s order to discontinue valproic acid and switch to lacosamide, the facility continued to administer valproic acid for an extended period. The medication administration records showed overlapping use of anticonvulsants and other psychotropic medications, with changes and discontinuations not aligning with hospital discharge instructions or family requests. The resident’s representative reported that the resident’s decline began shortly after participating in a facility event, and that the facility did not follow the neurologist’s orders to discontinue valproic acid. Hospital records indicated the resident was seen for altered mental status and somnolence, with explicit instructions to stop valproic acid and increase lacosamide if needed. However, the facility’s records showed continued administration of valproic acid even after these instructions, and the medication was not discontinued until several weeks later. Nursing notes and interviews with staff confirmed the resident’s decline in mobility and self-care, with staff unable to identify the cause at the time. Further review revealed that the resident was also receiving other medications with sedative effects, and a drug interaction check indicated a significant risk of increased sedation and drowsiness from the combination of valproic acid, olanzapine, and melatonin. Interviews with the DON and NHA confirmed a lack of awareness of the medication management issues during the period in question. The failure to appropriately manage and monitor the resident’s medication regimen led to a decline from independence to total dependence in mobility and self-care.