Failure to Follow Hospital Psychiatric Medication Recommendations
Penalty
Summary
The deficiency involves the facility’s failure to implement procedures to ensure accurate administration of prescribed medications for one sampled resident. Facility policies required a complete admission/readmission chart review within 24 hours to ensure follow-through of physician orders, and specified that psychotropic medications be used only when necessary and managed under the attending physician’s leadership in collaboration with the interdisciplinary team. Despite these policies, the facility did not follow the hospital discharge summary and psychiatric recommendations for the resident’s psychotropic medication regimen. The resident was admitted from an acute care hospital with diagnoses including cerebral palsy, anxiety, and depression, and was documented as cognitively intact with a BIMS score of 15. The hospital discharge summary and psychiatric recommendations indicated that, during a recent inpatient psychiatric stay, the resident’s Fluoxetine dose had been increased from 40 mg to 60 mg daily to address anxiety, panic, and depression, and that Trazodone 25 mg three times daily was to be given as needed for anxiety or sleep. The summary also stated that Lorazepam 0.5 mg twice daily was to be continued, with a recommendation that it be gradually decreased and eventually discontinued due to the resident’s age and documented memory deficits. Upon admission, the facility’s CRNP ordered Fluoxetine 20 mg once daily, later increasing it to 40 mg daily and changing the administration time, but the hospital-recommended 60 mg daily dose was not implemented until nearly two months after admission. Facility records showed that the resident did not receive the recommended 60 mg Fluoxetine dose for several weeks despite the documented need for this dose to manage psychiatric symptoms. Additionally, Lorazepam 0.5 mg twice daily was administered from admission until it was discontinued on a single date without any documented gradual dose reduction as recommended in the hospital discharge summary. During an interview, the DON was unable to provide documented justification for not implementing the recommended medication regimen to meet the resident’s psychiatric needs.
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