Failure to Ensure Appropriate Use and Consent for Psychotropic Medications
Penalty
Summary
The deficiency involves the facility’s failure to prevent the use of unnecessary psychotropic medications and to ensure a resident was free from unnecessary drugs. One resident with non-Alzheimer’s dementia and an anxiety disorder had an admission MDS showing a BIMS score of 8, indicating moderately impaired cognition, but no documented hallucinations, delusions, or behavioral symptoms such as aggression, wandering, or rejection of care. Despite this, the physician ordered Seroquel 25 mg twice daily for “vascular dementia manifested by manic behaviors,” and later increased the dose after reports of aggressive outbursts and confusion. The diagnosis of vascular dementia was used as the indication for the antipsychotic, and there was no documentation that the IDT evaluated the resident’s angry outbursts or hallucinations or identified and implemented person-centered non-pharmacological interventions before starting or increasing the Seroquel. The resident was also prescribed Ativan 0.5 mg by mouth at night as needed for anxiety and received multiple PRN doses over several days. Review of the medical record, including the Order Summary Reports, MARs, and care plans, showed that the facility did not incorporate the use of Seroquel and Ativan into the resident’s care plan with appropriate interventions. The DON was unable to provide IDT documentation or a care plan addressing the resident’s angry outbursts with person-centered non-pharmacological approaches prior to the administration of Seroquel, despite facility policies requiring thorough evaluation of behavioral symptoms and use of behavioral interventions unless contraindicated. Informed consent procedures for psychotropic medications were not followed as required. The Psychotherapeutic Drug Informed Consent forms for both Seroquel and Ativan did not contain documentation that informed consent was obtained from the resident’s representative prior to their use. The physician acknowledged not speaking directly with the resident’s representative regarding informed consent for these medications and stated that nurses were expected to obtain consent. The facility’s stated process was for licensed nurses to call the resident’s representative, explain the medication, its use, and side effects, and document consent, but this was not documented in the record for this resident. These omissions occurred despite facility policies stating that psychotropic medications may only be administered when necessary to treat a specifically diagnosed condition, with appropriate documentation, behavioral interventions, and informed consent obtained by the prescribing clinician.
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