Inadequate Indication for Antipsychotic (Seroquel) Use
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident’s drug regimen was free from unnecessary antipsychotic medication. A male resident with severe dementia, generalized anxiety disorder, major depressive disorder without psychotic features, and insomnia was admitted and later discharged from the facility. His Quarterly MDS showed severe cognitive impairment with a BIMS score of 4, no indicators of psychosis, and only limited behavioral symptoms. Despite this, the MDS reflected that he was taking an antipsychotic with an indication noted. The care plan initiated in early September documented a focus on antipsychotic medication related to major depressive disorder and insomnia due to another mental disorder. A consent form for Seroquel 200 mg at bedtime was signed by the responsible party and completed by a physician, listing diagnoses including severe dementia with agitation, major depressive disorder without psychotic features, late-onset Alzheimer’s disease, and unspecified anxiety disorder. The resident’s order summary showed Seroquel 200 mg by mouth at bedtime for dementia with severe agitation and unspecified anxiety disorder, with administration documented on the MAR from early to late January. An order for antipsychotic side effect monitoring every shift was also in place. During interviews, the DON stated that antipsychotics such as Seroquel were not indicated for dementia and was unable to explain why or what negative impact they could have. She reported that the diagnosis associated with Seroquel was later changed to insomnia and that the resident was receiving Seroquel for insomnia, anxiety, and major depressive disorder. A PA stated that the resident was also followed by a mental health provider and that antipsychotics should be used carefully in the elderly, noting both potential benefits and negative impacts. The facility’s policy on psychotropic medication and gradual dose reduction stated that physicians and mid-level providers would use psychotropic medications appropriately with interdisciplinary team involvement, but the survey findings concluded there was not an adequate indication for the use of Seroquel before its administration.
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