Inadequate Indication for Antipsychotic Use in Dementia Patient
Penalty
Summary
The facility failed to ensure a resident was free from chemical restraints that were not required to treat a medical symptom by administering the antipsychotic medication olanzapine (Zyprexa) without an adequate clinical indication. The resident was an elderly male with diagnoses of Alzheimer's disease and vascular dementia, and an MDS assessment showed a BIMS score of 3, indicating severely impaired cognition. The resident’s care plan and physician’s order documented the use of olanzapine 10 mg orally twice daily with the indication listed only as "Alzheimer's disease, unspecified," and the order did not include an end date. The MDS identified the resident as receiving a high‑risk antipsychotic, and the care plan interventions were limited to monitoring for side effects, effectiveness, and adverse reactions every shift. Record review of the e‑MAR showed that olanzapine 10 mg was administered over the reviewed period. During interviews, the pharmacist stated that Alzheimer's disease was not an appropriate diagnosis for an antipsychotic medication and that use of an antipsychotic in a resident with Alzheimer's disease could cause death. The ADON similarly stated that ordering an antipsychotic for Alzheimer's disease could cause death and was not recommended for residents with Alzheimer's or dementia. The DON confirmed the resident was on olanzapine and read the order from the computer, acknowledging that the indication of Alzheimer's disease was allowed because the resident came from the hospital with that order. The facility’s own antipsychotic medication use policy stated that antipsychotic medications may be considered for residents with dementia only after medical, physical, functional, psychological, emotional, psychiatric, social, and environmental causes of behavioral symptoms have been identified and addressed, but the documentation reviewed did not show such an indication or assessment beyond the Alzheimer's diagnosis.
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