Failure to Implement and Document Gradual Dose Reductions for Psychotropic Medications
Penalty
Summary
The facility failed to ensure that residents receiving psychotropic medications underwent required gradual dose reductions (GDRs) and behavioral interventions, unless clinically contraindicated, as part of efforts to discontinue these drugs. For three residents reviewed, there were lapses in following through with pharmacy recommendations and physician-approved dose reductions. Specifically, one resident with dementia and major depressive disorder continued to receive a higher dose of citalopram despite a physician-approved reduction, with the dose only being adjusted after surveyor intervention. Medication administration records confirmed the resident received the higher dose for over a month after the reduction was approved. Another resident with paranoid schizophrenia and depression was supposed to have their duloxetine dose reduced from 60 mg to 40 mg following agreement from a psychiatric nurse practitioner, but records showed the reduction was never implemented. The medication administration records indicated the resident continued to receive the higher dose for several months after the recommendation and approval for reduction. A third resident with bipolar disorder and schizophrenia was prescribed Invega Sustenna and olanzapine. Although pharmacy recommendations for GDRs were made, there was no documentation that these reductions were attempted or that behavioral interventions were implemented. Interviews with facility staff, including the ADON, DON, and Administrator, revealed a lack of awareness and oversight regarding the pharmacy recommendations and the status of GDRs. The facility's own policy required documentation of GDR attempts and outcomes, but such documentation was missing for these residents.