F0605

E

Failure to Discontinue or Justify Extended PRN Lorazepam Orders

Abilene, Texas Survey Completed on 01-22-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure residents were free from chemical restraints and that PRN psychotropic medications were managed according to regulatory and facility policy requirements. For one resident, a female with anxiety, dementia, and respiratory failure, the electronic physician orders showed a PRN lorazepam 0.5 mg tablet to be given every three hours as needed for anxiety/restlessness, starting in mid-October with no end date. Her discharge MDS assessment did not reflect the use of anti-anxiety medications, and physician progress notes from November through January contained no documented rationale for the continued provision of lorazepam or risperidone. The MAR showed lorazepam was administered once in December and once in January, and there was no documentation that the PRN order had been discontinued after 14 days or that a rationale for continuation had been entered.

Another resident, a female with Alzheimer’s disease, cognitive communication deficit, and depression, also had an electronic physician order for PRN lorazepam 0.5 mg every three hours as needed for anxiety, starting in early July with no end date. Her quarterly MDS assessment did not indicate that she was receiving anti-anxiety medications, and physician progress notes from November through January did not contain a documented rationale for the continued PRN lorazepam order. Review of her MAR for December and January showed that no doses of lorazepam were administered during those months, yet the PRN order remained active beyond 14 days without an end date or documented justification.

A third resident, a male with dementia, anxiety, and a history of cerebral infarction, had two active PRN lorazepam orders: 0.5 mg every two hours as needed and 1 mg (two 0.5 mg tablets) every two hours as needed for anxiety, agitation, or restlessness, both starting in early October with no end date. His quarterly MDS assessment did not show that he was receiving anti-anxiety medications, and physician progress notes from November through January lacked any documented rationale for the continued PRN lorazepam orders. MAR reviews for December and January showed no lorazepam doses administered. During an interview, the DON acknowledged that psychotropic PRN orders, including anti-anxiety medications, should not be scheduled for more than 14 days without appropriate documentation, and the facility’s psychotropic drug use policy specified that PRN psychotropic orders are limited to 14 days unless the physician documents a rationale and duration in the medical record.