Failure of Pharmacy Consultant to Identify Missing AIMS Assessments During Monthly Drug Regimen Reviews
Penalty
Summary
The deficiency involves the facility’s Pharmacy Consultant failing to identify and report irregularities related to required Abnormal Involuntary Movement Scale (AIMS) assessments during monthly drug regimen reviews for residents receiving antipsychotic medications. One resident was readmitted with diagnoses including unspecified dementia with behavioral disturbance, anxiety disorder with delusional thoughts and harmful behaviors, recurrent major depressive disorder, paranoia, restlessness, and a history of cerebral infarction. This resident had physician orders for Quetiapine Fumarate, an antipsychotic, but the medical record contained no AIMS assessment. Despite this, multiple monthly drug regimen reviews by the Pharmacy Consultant over several months did not document any need for an AIMS assessment. Another resident was readmitted with dementia with behaviors and generalized anxiety disorder and had an order for Olanzapine, an antipsychotic, with only one AIMS assessment on file since the last recertification survey. Subsequent monthly drug regimen reviews for this resident also lacked any notation that additional AIMS assessments were needed. Interviews further clarified the inactions contributing to the deficiency. The Pharmacy Consultant stated she did not think AIMS assessments still needed to be completed for residents on antipsychotic medications and reported that she rarely reviewed AIMS assessments unless staff reported possible side effects, adding that she had not seen AIMS forms in residents’ records. The DON reported being unaware whether the Pharmacy Consultant reviewed medical records for AIMS assessments and indicated that the Administrator reviewed the Pharmacy Consultant’s reports monthly. The Medical Director and Facility Physician both stated they were not aware that the Pharmacy Consultant was not performing complete medical record reviews that would include checking for AIMS assessments, and the Facility Physician stated he would expect a full medical record review each month. The Administrator reported she was unaware that AIMS assessments were not being reviewed and expected the Pharmacy Consultant to identify and report irregularities, including the need for AIMS assessments, during monthly drug regimen reviews, but did not realize this was not occurring when reviewing the monthly reports.
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