Failure to Ensure Appropriate Indication and Consent for Antipsychotic Medication Use
Penalty
Summary
The deficiency involves the facility’s failure to ensure appropriate use and documentation of antipsychotic medications, including having an appropriate diagnosis, identifying specific target behaviors, and maintaining required consents. For one resident (R9) with diagnoses including unspecified dementia without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, the DON initially provided only psychotropic consents for gabapentin and mirtazapine and confirmed these were all of the resident’s psychotropic consents. The ADON later identified that R9 was also receiving olanzapine for a psychotic disorder but could not locate a corresponding consent in the electronic medical record and did not respond when asked if olanzapine was appropriate for a resident with dementia. A signed consent for olanzapine dated 4/10/24 was later produced from the medical records office, and the ADON acknowledged it should have been in the electronic record but could not explain why it had not been uploaded or how it was located so quickly after more than a year. R9’s care plan noted use of olanzapine related to a mood disorder, and the physician order sheet documented olanzapine 2.5 mg at bedtime as an antipsychotic, with a psychotropic medication intervention review listing anxiety and agitation as targeted behaviors. However, prior to initiation of olanzapine, the psychiatry NP’s documentation described R9 as having dementia without behaviors, with fair judgment, fair short-term memory, adequate long-term memory, and ability to obey commands, and the NP repeatedly documented that gradual dose reduction was contraindicated even before any antipsychotic was started and continued this after olanzapine was initiated. The report notes that, per the FDA, olanzapine is approved for schizophrenia and is not approved for treatment of dementia-related psychosis, and that elderly residents with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death. Another resident (R8) was also identified as having dementia-related diagnoses, including unspecified dementia without behavioral disturbance, psychotic disturbances, mood disturbance, depression, and anxiety disorder, with an intact cognitive score, in the context of the facility’s failure to prevent unnecessary psychotropic medication use.
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