Failure to Care Plan Psychotropic Medication Use for Multiple Residents
Penalty
Summary
The deficiency involves the facility’s failure to develop person-centered, comprehensive care plans with measurable goals and interventions for residents receiving psychotropic medications. For one resident admitted with schizophrenia and a BIMS score of 0/15 indicating severe cognitive impairment, the admission MDS and CAA triggered the use of psychotropic medications and directed staff to develop a care plan. Despite a physician’s order for a monthly intramuscular antipsychotic injection, the resident’s care plan in the EMR did not contain any evidence that the use of aripiprazole was addressed. Another resident, cognitively intact with a BIMS score of 15/15, had physician orders for oral medications to treat bipolar disorder and major depressive disorder and was receiving an antipsychotic medication on a routine basis. The annual MDS and CAA triggered for psychotropic drug use and directed staff to develop a care plan, but the care plan did not address the use of quetiapine fumarate or escitalopram. A third resident, admitted with major depressive disorder and a BIMS score of 10/15 indicating moderate cognitive status, had an order for an oral antipsychotic medication and had been administered the medication twice daily, as shown on the MAR. The CAA documented that the resident had received antipsychotic medication for seven days prior to the assessment, yet the care plan dated later that month did not address the resident’s use of the antipsychotic medication. A fourth resident, cognitively intact with a BIMS score of 15/15 and diagnoses including schizophrenia and schizoaffective disorder with related depression, had orders for oral medications for these conditions. The annual MDS and CAA triggered psychotropic drug use for care planning, but the care plan, revised later in the year, only contained a Neurobehavioral Health problem and did not include a specific care plan for antipsychotic medications. During interviews, MDS coordinators stated that they complete the CAAs and then decide whether to develop a care plan, and reported that the EMR care plan system does not have the capacity to specifically address psychotropic medications or include black box warning information. The DON stated that care plans were individualized and that information about psychotropic use was contained in residents’ consents. The RAI Manual excerpt in the report states that MDS and CAA findings are to be used by the IDT to develop care plans that address identified problems, including psychotropic drug use.
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