Inappropriate Antipsychotic Use Without CMS-Approved Indication
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to ensure a resident remained free from chemical restraint through the inappropriate use of an antipsychotic medication without a CMS-approved indication. The resident had diagnoses including Alzheimer’s disease, cerebral infarction, insomnia, and major depressive disorder, with a BIMS score indicating severe cognitive impairment but no documented behaviors on the MDS during the assessment period. The care plan, initiated months earlier, described behaviors of resisting care and yelling out related to depression, anxiety, and dementia, and noted the use of Quetiapine (Seroquel) for these behaviors, but it did not include a psychiatric indication for the antipsychotic. The physician’s order renewed Quetiapine 12.5 mg daily for “unspecified dementia with psychotic disturbances,” and the resident had been admitted on this medication and diagnosis. Record review showed no behavioral monitoring related to the antipsychotic use, despite the resident’s psychotropic CAA identifying antipsychotic use and risk for adverse effects. Consultant pharmacist documentation over several months included a recommendation for gradual dose reduction of Quetiapine, which the provider declined, citing risk of decompensation, but the recommendations did not address the lack of an appropriate CMS indication for use in dementia. The facility was unable to provide a documented rationale for continued Quetiapine use without an appropriate CMS indication when requested. Observations showed the resident calm, engaged in group activity, and without behaviors at the time of surveyor observation. Interviews with facility staff confirmed that antipsychotics are not indicated for dementia alone and that dementia was the listed indication, with staff acknowledging that the resident’s representative refused changes to the medication or its indication. The facility’s own policy required psychotropic drugs to be used with specific diagnoses and to be closely monitored, but this was not supported by the documentation for this resident’s antipsychotic therapy.
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