Failure to Initiate Level II PASRR After New Schizophrenia Diagnosis
Penalty
Summary
The deficiency involves the facility’s failure to submit a required Level II Preadmission Screening and Resident Review (PASRR) referral for a resident who developed and was documented with a new mental health diagnosis after admission. A Level I PASRR was completed prior to admission with instructions to resubmit paperwork for a Level II PASRR if a new mental health diagnosis was suspected or if there was a significant change in condition. The resident’s hospital discharge summary documented hallucinations, delusions, and treatment with multiple antipsychotic and anti-anxiety medications, but did not list a diagnosis of schizophrenia. Upon admission, the resident’s EMR showed no mental health diagnoses, and the admission MDS later reflected that the resident had schizophrenia and had received antipsychotics, anti-anxiety medications, and anticonvulsants during the look-back period, while still indicating only a Level I PASRR. Subsequent psychiatric evaluation documented that the resident had a history of military service, long-standing mental illness related to war experiences, hallucinations, paranoia, and an incident in the hospital where a nurse was physically injured. The psychiatric NP confirmed that the resident reported a history of paranoid schizophrenia and that this history was verified with a family member. The resident was diagnosed in the facility’s EMR with paranoid schizophrenia on a specific date, but there was no evidence in the record that a Level II PASRR referral was submitted following this new diagnosis, despite the prior Level I PASRR instructions and the resident’s mental health history and current psychotropic medication regimen. Interviews with facility staff revealed communication and process failures that contributed to the lack of a Level II PASRR referral. The MDS Coordinator stated she identified the paranoid schizophrenia diagnosis from a psychiatric note and reported it to the former social worker, who no longer worked at the facility, but could not recall when this occurred. The MDS Coordinator and the former social worker did not have access to submit Level II PASRR requests and were reliant on the Assistant Business Office Manager, who reported she had not received any information or request regarding this resident and typically received such information during morning clinical meetings. The Administrator acknowledged that a Level II PASRR should be completed upon admission of a resident with a mental health diagnosis or when a new mental health diagnosis or change in condition occurs, and stated that the resident should have had a Level II PASRR referral when the paranoid schizophrenia diagnosis was added, but could not explain why the referral was not submitted.
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