Failure to Perform Required AIMS Assessments for Residents on Antipsychotic Medications
Penalty
Summary
The deficiency involves the facility’s failure to conduct ongoing Abnormal Involuntary Movement Scale (AIMS) assessments for residents receiving antipsychotic medications. For one resident with dementia with behaviors and generalized anxiety disorder, the physician ordered nightly olanzapine 2.5 mg, and the active care plan identified a risk for complications related to psychotropic and antipsychotic medications with an intervention specifying AIMS testing per protocol. However, the medical record contained only a single AIMS assessment dated 3/10/25, with no additional AIMS assessments found. Another resident, admitted with unspecified dementia without behavior, psychotic disturbance, mood disturbance, and anxiety, had a physician order for daily olanzapine 5 mg. The active care plan for this resident included interventions to monitor and document side effects and effectiveness of olanzapine but did not include any intervention for completing an AIMS assessment. The quarterly MDS documented that this resident was severely cognitively impaired and received antipsychotic medications, yet review of the medical record revealed no AIMS assessments had been completed. A third resident, readmitted with diagnoses including unspecified dementia with behavioral disturbance, anxiety disorder with delusional thoughts and harmful behaviors, major depressive disorder with paranoia and restlessness, and a history of cerebral infarction, had an active care plan after readmission that did not address antipsychotic medication. A subsequent physician order prescribed quetiapine 50 mg in the morning and 100 mg at bedtime for anxiety disorder and recurrent major depressive disorder. The quarterly MDS showed this resident was cognitively intact, had verbal behaviors toward others on some days, and routinely received antipsychotic and antidepressant medications, with the last GDR documented on 5/19/25. Despite this, there were no AIMS assessments in the medical record. Interviews with the DON, consultant pharmacist, medical director, facility physician, and administrator revealed a lack of awareness of AIMS requirements, absence of a process to track when AIMS were due, and system and staffing changes that contributed to AIMS assessments not being completed as needed.
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