Failure to Administer and Monitor Anticonvulsant Therapy for Residents With Seizure Disorders
Penalty
Summary
The facility failed to ensure seizure medications were administered according to professional standards for two residents with seizure disorders. One resident with a history of seizures and conversion disorder was ordered Levetiracetam (Keppra) 1000 mg orally every 12 hours. The Medication Administration Record (MAR) for that month showed missed doses at 9 a.m. on one date and 9 p.m. on the following date. An order administration note documented that the 9 a.m. dose was not given because the facility was waiting for the medication to be delivered, and there was no documentation that staff followed up with the pharmacy to ensure timely delivery. Nursing progress notes showed the resident was sent to a general acute care hospital later that afternoon due to a seizure and was readmitted the next evening, yet there was no documentation explaining why the 9 p.m. dose of Keppra was not administered upon readmission. For the same resident, the MAR showed a PRN order for Lorazepam (Ativan) 2 mg/mL IM every five minutes as needed for seizures, up to three doses, but there was no indication that Ativan was administered when the resident experienced the seizure that led to transfer to the hospital. Review of active and discontinued orders for the month showed no orders for monitoring Keppra blood levels. Interviews with LVNs revealed that Keppra doses were not documented when given, one dose was charted on the wrong date, and there was no documented evidence of pharmacy follow-up when the medication was reportedly unavailable. The interim DON stated that Keppra levels should have been obtained on initial assessment and readmission per facility policy, but there was no record of any Keppra levels for this resident. A second resident with epilepsy, described as intractable without status epilepticus, was ordered Divalproex Sodium (Depakote) 750 mg twice daily. Review of the MAR for the same month showed that the 9 a.m. doses on two consecutive days were not administered. An LVN stated that these doses were not given because the Depakote was not available in the medication cart. Another LVN stated that staff should have called the physician for orders when Depakote was not available and that the resident should have received the missed doses to prevent seizures. Review of the resident’s progress notes for those dates did not show documentation explaining the missed doses. Facility policies on medication administration and care for residents with seizure disorders required timely administration, immediate documentation on the MAR, and assessment and documentation of anticonvulsant blood levels, which were not followed in these cases.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.