Failure to Complete Required Lab Monitoring for Anticonvulsant Therapy
Penalty
Summary
Surveyors identified a deficiency related to failure to ensure a resident’s drug regimen was free from unnecessary drugs by not completing required blood monitoring for an anticonvulsant medication. The resident had multiple diagnoses including dementia, psychosis, anxiety, anemia, atherosclerotic heart disease, severe protein-calorie malnutrition, spondylosis, hypertension, dysphagia, hydronephrosis, hypotension, obstructive and reflux uropathy, and atrophy of the kidney. A quarterly MDS assessment documented that the resident was receiving antianxiety, antidepressant, anticonvulsant, and hypnotic medications. The care plan, initiated in mid-November, identified the resident as being at risk for adverse side effects related to anticonvulsant/antiseizure medication use, with interventions that included obtaining labs as ordered. Physician’s orders showed that Divalproex (Depakote) 125 mg, two capsules twice daily, was started in mid-November, and MARs for November, December, January, and February showed the resident received this medication continuously from mid-November through late February. A physician’s order dated in mid-November directed a one-time blood draw for ammonia and valproic acid levels, but this lab order was discontinued later in November without the tests ever being completed. During interviews, the DON acknowledged that the valproic acid level was intended to be drawn and that no lab results could be found in the chart. The DON further stated that the lab order had been discontinued later in November after being ordered earlier that month. The Regional Director of Clinical Services confirmed that the resident had not had any valproic acid or ammonia levels monitored at all while receiving Divalproex. The facility’s policy on lab and radiology tracking, provided by the DON, required confirmation that each ordered lab was obtained and that any labs not resulted as expected be investigated, but the ordered monitoring labs for this resident were not completed or followed up, leading to the cited deficiency.
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