Failure to Notify Physician of Repeated Medication Refusal
Penalty
Summary
The facility failed to notify a resident's physician of the resident's repeated refusal of buspirone hydrochloride, a medication prescribed for generalized anxiety disorder. The resident, who had diagnoses including recurrent enterocolitis due to C. diff, generalized muscle weakness, essential hypertension, and anxiety disorder, was admitted with intact cognitive skills and was dependent on staff for certain activities of daily living. According to the Medication Administration Record, the resident refused the prescribed buspirone on ten occasions over several days before the medication was discontinued. Despite the facility's policy requiring physician notification after two or more consecutive refusals of medication, there was no documented evidence that the physician was informed of these refusals. Interviews with the Assistant Director of Nursing and the Director of Nursing confirmed that the nurses should have completed a Change in Condition Evaluation form and notified the physician regarding the resident's medication refusal. The resident reported refusing the medication because it was not effective and stated that this was communicated to the nursing staff, but the medication continued to be offered. The facility's policy also required documentation of changes in the resident's medical or mental condition, which was not completed in this case.