Failure to Complete Ongoing AIMS Assessments for Residents on Antipsychotics
Penalty
Summary
The facility failed to provide ongoing Abnormal Involuntary Movement Scale (AIMS) assessments for residents receiving antipsychotic medications, as required by protocol. For two residents with diagnoses including depression with psychosis and bipolar disorder, medical records showed that only one AIMS assessment was completed for each resident, with significant lapses in subsequent assessments. Care plans for both residents indicated a risk for complications related to psychotropic and antipsychotic medications and included interventions for AIMS testing per protocol, but these interventions were not consistently implemented. Interviews with facility staff, including the DON and the pharmacy consultant, confirmed that AIMS assessments were to be conducted every six months for residents on antipsychotics. However, the DON stated that the electronic medical record (EMR) system may not have been properly set to trigger reminders for these assessments, resulting in missed assessments. Unit management staff were unaware of the need for ongoing AIMS assessments for the affected residents, and the pharmacy consultant could not recall discussing the assessments with the DON. The administrator confirmed that the DON was responsible for ensuring completion of AIMS assessments.