Failure to Notify Physician of Repeated Refusals of Mood Stabilizer
Penalty
Summary
The deficiency involves the facility’s failure to notify a physician in a timely manner about a resident’s frequent refusals of a prescribed mood stabilizer, Depakote, as required by facility policy. The facility’s Medication Administration Policy states that medication refusals must be reported to the prescriber after a specified number of doses are refused and that refusals of vital medications over a certain number of consecutive doses require physician notification and documentation of the response. One resident, admitted with diagnoses including Schizoaffective Disorder, Major Depressive Disorder, Panic Disorders, and Mild Intellectual Disabilities, had a care plan indicating use of Depakote as a mood stabilizer for aggressive mood and directing nursing staff to monitor for adverse reactions and report symptoms of schizoaffective disorder to the MD. The care plan also documented a change in the resident’s usual behavior, including increased restlessness, fidgetiness, lack of initiative, and irritability, with an intervention to evaluate whether behavior was attributable to organic causes or other risk factors. Review of the resident’s MARs showed repeated refusals of Depakote over several months: 23 refusals out of 90 doses in one month, 27 refusals out of 93 doses the following month, and 7 refusals out of 37 doses in the subsequent partial month, totaling 57 missed doses in the latter two periods alone. The electronic medical record did not contain documentation of these multiple refusals over the review period. The resident’s physician stated he was not aware of the missed doses and did not recall being notified of the ongoing problem, and affirmed he would want to be notified of regular medication refusals, especially for Depakote. The Administrator confirmed the policy did not specify the exact number of doses that could be missed before physician notification, and the DON verified that the resident was regularly refusing the noon dose of Depakote and that there was no documentation of physician notification regarding these refusals during the identified period.
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