Failure to Honor POA Refusal for Antidepressant Administration
Penalty
Summary
A deficiency occurred when the facility failed to honor the wishes of a resident's Power of Attorney (POA) regarding the administration of an antidepressant medication. The resident, who had multiple diagnoses including congestive heart failure, cognitive communication deficit, major depressive disorder, and osteoarthritis, was admitted to the facility and subsequently had an order placed by a Nurse Practitioner for Zoloft. The Registered Nurse (RN) received the order and delegated it to the next shift, but after speaking with the resident's POA, who declined consent for the medication, the RN forgot to discontinue the order in the Electronic Medical Record (EMR). As a result, the medication remained active on the Medication Administration Record (MAR), and Licensed Practical Nurses (LPNs) continued to administer Zoloft to the resident without the required consent. The issue was discovered during a care plan meeting when the POA became aware that the resident had been receiving Zoloft despite his explicit refusal. Documentation in the progress notes confirmed that the POA had declined the medication and did not want it administered. The facility's policy required nursing staff to obtain all necessary consents from the POA for psychotropic medications, but this protocol was not followed, resulting in the resident receiving medication against the POA's wishes for nearly two weeks.