Deficiencies in Psychotropic Medication Management and Monitoring
Penalty
Summary
The facility failed to comply with regulatory requirements regarding the use and monitoring of psychotropic medications for several residents. For one resident with major depressive disorder and dementia, PRN (as needed) psychotropic medication orders for ABH Gel and Seroquel were issued without a documented 14-day stop date or rationale for continued use, contrary to facility policy. Interviews with the Nursing Home Administrator (NHA) and Director of Nursing (DON) confirmed that such orders should have a 14-day stop date documented and followed. Additionally, two residents receiving psychotropic medications, including antipsychotics and anxiolytics, did not have documented monitoring for side effects as required. One resident with dementia, agitation, and depression had multiple psychotropic medications ordered, but there was no documentation of side effect monitoring in the clinical record. The NHA confirmed that side effect monitoring should have been in place. Another resident with major depressive disorder and anxiety disorder was prescribed Lorazepam gel after previously refusing the oral form, but there was no documentation of side effect or behavior monitoring, nor evidence of nonpharmacological interventions or care planning for medication refusal. Furthermore, the facility failed to obtain proper informed consent for the initiation of psychotropic medication for a resident with anxiety disorder and paranoid schizophrenia. The clinical record lacked a signed informed consent form from the resident or their representative for the use of olanzapine. The NHA stated that it was the facility's expectation to obtain such consent. These deficiencies were identified through policy reviews, clinical record reviews, and staff interviews.