Inappropriate Use of Antipsychotic Medication Without Clear Indication
Penalty
Summary
The deficiency involves the facility’s failure to provide an appropriate indication for the use of an antipsychotic medication for one resident. Facility policy on psychotropic medications states that such drugs are to be used only when nonpharmacological interventions are clinically contraindicated, to treat specific, diagnosed, and documented conditions, and not as chemical restraints. The drug reference used by the facility lists quetiapine (Seroquel) as an antipsychotic indicated for schizophrenia, with certain off-label uses, and specifies it is not to be given to elderly patients with dementia-related psychosis. The resident in question was admitted with diagnoses including unspecified dementia with other behavioral disturbance, cognitive communication deficit, insomnia, and a history of falls. The MDS assessment documented that the resident was cognitively intact and had no behaviors, while the care plan documented that the resident was on psychotropic medications for dementia with other behavioral disturbance and insomnia. Physician orders dated at admission documented Seroquel 25 mg at bedtime for dementia with behavioral disturbance. During interviews, an RN described the resident’s behaviors mainly as exit seeking and lack of safety awareness, noting that the resident was usually easily redirected and required supervision, especially at night. The DON stated that the resident had been “good” since admission, with dementia and lack of safety awareness as the primary issues, and indicated a belief that the resident was appropriate for dose reduction to discontinue Seroquel. The DON agreed that antipsychotic medications should not be used in dementia patients but did not clearly state that the indication for Seroquel in this case was inappropriate. Overall, the documentation and staff interviews did not establish an appropriate, specific, and documented indication for the antipsychotic medication consistent with facility policy and the drug reference.
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