Failure to Ensure Required Stop Date for PRN Psychotropic Medication
Penalty
Summary
A deficiency occurred when a resident with diagnoses including anxiety disorder and depression was prescribed lorazepam, an anti-anxiety medication, on an as-needed basis without the required 14-day stop date or a documented rationale from the physician for omitting the stop date. The medication order, signed by the physician, instructed administration of lorazepam 0.5 mg every 6 hours as needed for anxiety or restlessness. Facility staff, including a licensed nurse and the Assistant Director of Nursing, confirmed that as-needed psychotropic medications are expected to have a 14-day stop date to ensure periodic evaluation of the medication's necessity and safety. However, the order for lorazepam did not include this stop date, and there was no documentation from the physician explaining the omission. Record review showed that the resident received lorazepam on three consecutive days without a stop date in place. The Minimum Data Set Coordinator and the facility pharmacist both confirmed that as-needed anti-anxiety medications require a specified duration or stop date to prompt re-evaluation before continuation. The facility's policy also states that PRN psychotropic drug orders, except for antipsychotics, are limited to 14 days unless the attending physician documents a rationale and indicates a duration for the order. In this case, the required documentation and stop date were missing, resulting in the administration of lorazepam without proper oversight.