Failure to Provide Ordered Psychotropic Medication and Mental Health Services
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident with multiple mental health and neurological diagnoses received ordered psychotropic medication and appropriate mental health services. The resident was admitted with Parkinson’s disease, major depressive disorder, anxiety disorder, dementia, and an amnestic disorder, and hospital discharge instructions showed an order for Nuplazid 34 mg daily. Facility physician orders also reflected Nuplazid 34 mg daily for delusions. The care plan identified alteration in neurological status related to Parkinson’s and dementia, and a mood problem, with interventions including administering medications as ordered, obtaining behavioral health consults as ordered or indicated, and monitoring and reporting significant mood and behavior changes to the physician. However, the MAR for a portion of December showed Nuplazid was not administered on multiple days and was documented as “waiting on delivery from pharmacy” on several dates. Despite this, the MAR also showed Nuplazid as signed out as administered on other dates during the same period, and behavior monitoring documented only insomnia and wandering initially, followed by aggressiveness and avoidance/resisting care on later dates. Progress notes indicated that on one date the resident was agitated, hitting and kicking staff, and that Nuplazid could not be delivered due to high cost, with psychiatry reportedly aware and new orders awaited; a later note documented that a family member was called to supply Nuplazid. Pharmacy records showed only a three-day supply of Nuplazid was ever delivered and that the DON had twice called instructing the pharmacy not to send the medication. There was no documentation that psychiatry actually saw the resident in the facility, and no follow-up documentation related to the progress note about agitation and medication unavailability. The DON and NHA confirmed the resident did not receive the ordered Nuplazid for several days, that psychiatry did not see the resident, and that there was no facility policy related to psychiatry services or mental health care, despite an existing policy requiring medications to be administered as ordered and deviations to be documented with physician notification.
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