Medication Regimens Lacking Diagnosis-Based Indications and Complete Orders
Penalty
Summary
The deficiency involves the facility’s failure to ensure that residents’ drug regimens were free from unnecessary drugs by not providing adequate, diagnosis-based indications for use and complete medication orders. For one resident with COPD, hypertension, and hyperlipidemia, the physician order for aspirin 81 mg daily listed the indication only as “preventative,” without specifying the clinical reason for use. The DON confirmed that “preventative” is not an appropriate indication and that the order did not meet her expectations. Another resident with gastroenteritis, colitis, hypotension, chronic pain, constipation, paraplegia, and major depressive disorder had an order for Acidophilus Probiotic that lacked a clear indication of use and did not include the dosage. The order also contained a discrepancy between the form ordered (tablet) and the form to be given (capsule). The DON confirmed that “probiotic” was not an appropriate indication, that the dosage was missing, and that the form of the medication in the order and instructions should match. For a third resident with emphysema, anemia, Bell’s palsy, and cerebral ischemic attack, there were orders for potassium chloride ER for hypokalemia, atorvastatin for hyperlipidemia, and Colace for constipation, even though the resident did not have diagnoses of hypokalemia, hyperlipidemia, or constipation. This resident also had an aspirin order with the indication “prophylactic” and a standing naloxone order despite having no current opioid medications. The DON confirmed that the indications did not relate to the resident’s diagnoses and that the naloxone order was not appropriate in the absence of opioid use. A fourth resident with depression, insomnia, cerebral infarction, and hyperlipidemia had orders for cetirizine for allergies and cephalexin for a UTI, but there were no corresponding diagnoses of allergies or UTI listed. This resident also had an aspirin order with the indication “preventative,” which the DON stated was not an appropriate indication. A fifth resident with respiratory failure, anxiety disorder, history of ischemic attack, dissociative identity disorder, bipolar disorder, and major depressive disorder had an order for furosemide for bilateral lower edema, although edema was not listed as a diagnosis, and an aspirin order with the indication “prophylactic.” The DON confirmed that this resident did not have a diagnosis of edema and that the medication indications did not relate to the resident’s diagnoses, and again stated that “prophylactic” was not an appropriate indication of use.
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