Failure to Monitor Behaviors for Resident on Antipsychotic Medication
Penalty
Summary
The deficiency involves the facility’s failure to monitor and document behavioral symptoms for a resident receiving an antipsychotic medication. The resident had diagnoses including bipolar disorder, COPD, and hypertension, with an MDS showing moderately impaired cognitive skills and a need for moderate assistance with several ADLs. The resident was prescribed quetiapine 100 mg at bedtime for bipolar disorder manifested by aggressive angry outbursts, and the care plan directed staff to monitor and record occurrences of these target behavior symptoms. The initial psychiatric evaluation indicated that medications were to be titrated according to the resident’s symptoms. Record review and staff interviews showed that although the resident had been treated with quetiapine since mid-November, behavior monitoring every shift for aggressive angry outbursts did not begin until January 20. RN 1 confirmed that from the start of quetiapine therapy through January 19, the resident was not monitored every shift for aggressive angry outbursts, despite orders and care plan requirements to do so. RN 1 and the DON both stated that licensed nurses were responsible for monitoring and documenting the number of behavior occurrences each shift so that the physician could evaluate the effectiveness of the antipsychotic, identify trends, and consider dose adjustments or GDR. Facility policies on antipsychotic medication use and behavioral assessment required staff to observe, document, and report information on target behaviors and medication efficacy, which was not done for this resident during the identified period.
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