Failure to Ensure Proper Use and Monitoring of Psychotropic Medication
Penalty
Summary
The facility failed to ensure that a resident's right to be free from chemical restraints was upheld, specifically regarding the use of Seroquel, an antipsychotic medication. The resident, who had diagnoses including unspecified dementia without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, was prescribed Seroquel 200mg at bedtime. Documentation did not show a clear clinical indication for the continued use of this psychotropic medication, and there was no evidence of behaviors that would warrant its use. The resident's care plan referenced the medication for behavior management and disease process, but lacked a specific care plan for any particular behavior, and there was no documentation of side effect or behavior monitoring as required. Review of the resident's medical records, including the quarterly MDS assessment and physician's orders, revealed that the antipsychotic medication was being administered daily without attempts at gradual dose reduction (GDR) or documentation of clinical contraindication for not attempting GDR. Pharmacy records indicated a request for GDR was made and signed by the nurse practitioner, but there was no acknowledgment or follow-up by the physician, nor was there documentation justifying the continued use of the medication. Interviews with facility staff confirmed that the required monitoring and documentation were not completed, and staff were unsure why the medication had not been reduced or why clinical contraindications were not documented. Observations of the resident showed that he was frequently in bed with his eyes closed, and staff interviews indicated that he did not exhibit significant behaviors, only occasional wandering. The facility's policy required that psychotropic medications be used only with proper clinical indication, that GDRs be attempted unless contraindicated, and that monitoring be performed by the DON, pharmacist, and medical director. These requirements were not met in this case, resulting in the deficiency.