Lack of Appropriate Diagnosis for Antipsychotic Medication Use
Penalty
Summary
The facility failed to ensure that an appropriate diagnosis and specific behavioral indication were present for the use of an antipsychotic medication in one resident. Interviews and record reviews revealed that a resident was receiving Seroquel (quetiapine fumarate) for agitation, but there was no documented psychiatric diagnosis or behavioral manifestation to justify the use of this psychotropic medication. The Assistant Director of Nursing (ADON) acknowledged that the resident was on hospice care and suggested contacting the hospice physician to add a diagnosis after the medication had already been initiated. The Director of Nursing (DON) deferred responsibility for psychotropic medications to the ADON and did not provide further information. The resident in question had diagnoses of Alzheimer's disease and moderate dementia without behavioral, psychotic, or mood disturbances. The physician order sheet indicated quetiapine was prescribed for monitoring related to dementia, but the medication administration record showed ongoing administration without evidence of psychiatric manifestations or behavioral conditions. The psychotropic drug review noted no attempts at gradual dose reduction and no psychiatric symptoms. The care plan referenced the need for psychotropic medication but did not include an associated diagnosis. Facility policy requires a supporting psychiatric diagnosis for antipsychotic use in residents with dementia, which was not present in this case.