Failure to Apply 14-Day Limits and Rationale for PRN Psychotropic Medications
Penalty
Summary
The facility failed to limit PRN psychotropic medications to 14 days for one resident when a PRN haloperidol injection and a PRN lorazepam tablet were ordered without appropriate 14‑day stop dates. The resident was admitted on 9/12/24 and had a quarterly MDS on 3/6/25 documenting a BIMS score of 9, indicating moderate cognitive impairment. On 3/9/25, a physician ordered haloperidol 5 mg/mL IM every four hours as needed for agitation with an indefinite stop date, and on 3/31/25, a physician ordered lorazepam 0.5 mg by mouth every six hours as needed for generalized anxiety disorder for 180 days. During interviews, the RN and the NHA stated that the facility’s expectation was that all PRN medications have a 14‑day stop date so the provider can evaluate usage, and both confirmed that the haloperidol and lorazepam orders did not have the required 14‑day limitation. The RN and NHA also confirmed that the physician’s progress notes lacked documentation of a rationale to extend the PRN lorazepam order to 180 days, despite the resident not using the medication consistently. These findings were confirmed with facility leadership, including the NHA, DON, and corporate representative, and the NHA acknowledged that the resident’s record did not contain evidence supporting the extended PRN lorazepam order beyond the standard 14‑day period.
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