Failure to Monitor Psychotropic Medications for Effectiveness and Side Effects
Penalty
Summary
The deficiency involves the facility’s failure to ensure adequate monitoring for effectiveness and side effects of psychotropic medications for multiple residents. The facility’s own policy on Medication Administration Safety; Psychotropic Medications and New Medication Orders requires that nonpharmacological interventions be attempted before psychotropic medications are ordered, and that new medications be monitored for effectiveness and side effects, with systems in place for re-evaluation by the IDT and care plan interventions addressing monitoring. Despite this policy, record reviews for several residents on psychotropic medications did not contain evidence of such monitoring. One resident with schizoaffective disorder was prescribed lithium carbonate and olanzapine, with a care plan directing monitoring of medication effectiveness, side effects, mood, and behaviors, yet the clinical record lacked documentation of this monitoring. Another resident with dementia was prescribed memantine, Rexulti, Seroquel, and trazodone, and had a care plan focus identifying risk for adverse effects from daily psychotropic use with an intervention to monitor mood/behavior and report adverse effects or ineffectiveness, but the record similarly lacked evidence of monitoring for effectiveness and side effects. A third resident with Alzheimer’s disease was prescribed Seroquel, trazodone, mirtazapine, and olanzapine, with a care plan intervention to monitor for changes in mood/behavior and adverse effects, but again, no documentation of such monitoring was found in the record. Additional residents were affected in the same manner. One resident with major depressive disorder was prescribed buspirone and venlafaxine, with a care plan focus on risk for adverse effects from psychotropic medications and an intervention to monitor mood/behavior and report side effects or ineffectiveness, yet the record contained no evidence of monitoring. Another resident with bipolar disorder was prescribed clozapine, divalproex, mirtazapine, and sertraline, with a care plan intervention to monitor for adverse effects and report changes, but the record also lacked documentation of monitoring for effectiveness and side effects. In interviews, the physician stated an expectation that staff continuously monitor residents’ behavior and attempt nonpharmacological interventions before starting psychotropic drugs. An RN reported there was no system in place for documenting residents’ behaviors, and the DON stated she expected behavior monitoring for psychotropic effectiveness and side effects and orders for nonpharmacological interventions prior to drug therapy, but could not show evidence that such monitoring occurred for the cited residents.
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