Failure to Justify Antipsychotic Use Without Appropriate Diagnosis
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary drugs by not having an appropriate diagnosis or identified behavior to justify the use of an antipsychotic medication. Specifically, a resident was receiving quetiapine fumarate (Seroquel) for agitation, but there was no documented psychiatric diagnosis or behavioral manifestation to support its use. Interviews with the ADON revealed uncertainty about the necessity of a diagnosis prior to initiating psychotropic medication, and the DON deferred responsibility for psychotropic medications to the ADON. The resident's physician order sheet listed quetiapine for dementia without behavioral disturbance, and the medication administration record showed ongoing administration of the drug over several months. Further review of the resident's records, including the psychotropic drug review and care plan, indicated that the resident did not exhibit psychiatric manifestations or behavioral conditions, and no gradual dose reduction had been attempted. The facility's own policy required a supporting psychiatric diagnosis for antipsychotic use in residents with Alzheimer's or dementia, but this was not present in the documentation. The lack of a specific diagnosis or behavioral justification for the antipsychotic medication constituted a failure to comply with requirements for unnecessary medications.