Failure to Honor Resident's Right to Refuse Medication
Penalty
Summary
The facility failed to honor a resident's right to refuse or discontinue treatment, specifically regarding the administration of Depakote, an antipsychotic medication. The resident in question was a male with Alzheimer's disease and unspecified dementia, who was unable to communicate effectively and required significant assistance with daily activities. Despite the resident's representative (RP) explicitly requesting that Depakote be discontinued, the medication continued to be administered. The RP stated that she had not given consent for Depakote and had communicated her wishes to stop the medication during a care plan meeting attended by family members and facility staff. However, documentation of this request was not reflected in the care plan notes, and the medication was not discontinued following the RP's request. When the RP contacted the Director of Nursing (DON) to reiterate her request to stop Depakote, the DON informed her that verbal consent had previously been obtained and that the medication would not be discontinued until the primary care provider (PCP) could be consulted. The DON attempted to contact the PCP's office, but it was closed for the weekend. The DON then claimed to have spoken with a nurse practitioner (NP), who allegedly advised against discontinuing the medication until the PCP could be reached. However, subsequent interviews revealed that the NP was out of town and did not speak with the DON, and no discontinuation order was given. The RP made further attempts to communicate with the DON but did not receive a response. Interviews with facility staff, including the Assistant Director of Nursing (ADON), Administrator, and other nurses, revealed a lack of clear policy or consistent practice regarding honoring a resident or RP's request to stop a medication. Some staff believed the medication should be placed on hold and the physician notified, while others deferred to the physician's decision even if the RP requested discontinuation. The facility's policy on resident rights emphasized the right to refuse treatment, but there was no specific policy addressing the process for discontinuing medications at the request of a resident or their representative.