Failure to Inform POAs of Psychotropic Medication Risks and New Skin Conditions
Penalty
Summary
The deficiency involves the facility’s failure to ensure residents and/or their POAs were informed of the risks, benefits, side effects, and alternative treatment options before initiating or continuing antipsychotic and other psychotropic medications, and failure to notify a POA of new skin conditions. For one resident admitted with delusional disorder, restlessness, agitation, and anxiety disorder, the record showed existing orders for Risperidone and Depakote. The facility’s policy on psychotropic medication use required that residents and/or representatives be educated on risks, benefits, and non-pharmacological alternatives. Care plan meeting notes for this resident over multiple dates only indicated that psychoactive medications were prescribed and that family/resident were educated, but contained no details of risks, benefits, side effects, or alternative options. Progress notes over several months also lacked documentation of such education, and the resident’s POA confirmed that no education on these topics had been provided. Another resident admitted with anxiety disorder and bipolar disorder had orders for Risperdal and Xanax. Review of this resident’s medical record revealed no documentation that the resident or responsible party had been educated on the risks, benefits, or alternative/non-pharmacological interventions for these medications. A third resident admitted with major depressive disorder had an order for Mirtazapine, but the medical record similarly contained no documentation that the resident or responsible party received education on the risks, benefits, or alternative treatments for this antidepressant. In interviews, the DON stated that medications are reviewed with residents or responsible parties during care plan meetings, but acknowledged there was no documentation of risk/benefit or alternative treatment education for these medications. For another resident with multiple dementia-related diagnoses, major depressive disorder in remission, and bipolar disorder, the admission record showed a POA for healthcare and orders for Olanzapine at two different dosages. Nursing notes for the period surrounding the initiation of a new Olanzapine order did not document that the POA was informed of the new antipsychotic prescription, its side effects or risks, or any alternative treatment options. The DON confirmed that the POA was not notified of the new treatment’s risks, benefits, side effects, or alternatives prior to prescription and dispensing, and that notification occurred only later during care plan meetings. A further resident with a history of mental and behavioral disorders, dementia, and major depressive disorder in remission had a POA for healthcare and orders for a compounded topical preparation containing Ativan, Benadryl, and Haldol applied to the neck and wrists on a scheduled basis. The DON stated that the POA was not notified of the side effects, risks, benefits, or alternative options for this treatment prior to it being prescribed and dispensed, and that notification occurred during care plan meetings. Care plan notes indicated the POA attended and participated in plan development and was notified of psychoactive medications and educated at those meetings. Separately, this same resident developed multiple new skin issues on both feet and the right heel, documented in progress notes and wound history beginning on a specific date. The resident’s POA reported being unaware of any current skin issues, and an LPN confirmed there was no communication with the POA regarding the foot wounds or related interventions, demonstrating a failure to notify the POA of a change in skin condition.
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