Inappropriate Use and Administration of Antipsychotic Medications
Penalty
Summary
The facility failed to ensure that antipsychotic medications were used appropriately and that behavior monitoring was resident-specific for two residents with diagnoses including schizoaffective disorder and paranoid schizophrenia. Physician orders for these residents required monitoring of 'refusal of care every shift' as an indicator for antipsychotic medication effectiveness. Interviews with nursing and mental health staff revealed that refusal of care is a resident right and should not be used as a behavioral indicator for antipsychotic medication monitoring. The Director of Nursing acknowledged that the behavior monitoring was too broad and not resident-specific, and that refusal of care should not be the sole behavior monitored. Additionally, the facility did not administer PRN intramuscular (IM) Zyprexa as ordered for one resident. The medication administration records showed that IM Zyprexa was given at times that did not correspond with the scheduled oral doses, and sometimes outside the prescribed administration window. Both the licensed nurse and mental health case manager confirmed that the IM Zyprexa was to be administered only when the oral dose was refused and within a specific time frame, which was not consistently followed. The physician's orders for IM Zyprexa were described as confusing, and there was no documentation to support late administration or deviations from the prescribed schedule. Facility policies required medications to be administered according to prescriber orders and within one hour of the scheduled time. However, the review of records and staff interviews confirmed that these policies were not followed for the administration of antipsychotic medications. The lack of clear, resident-specific behavior monitoring and failure to adhere to medication administration protocols resulted in residents being at risk for receiving unnecessary antipsychotic medications and not having their right to refuse care respected.