Lack of Physician Rationale for Antipsychotic Use in Residents With Dementia
Penalty
Summary
Surveyors found that the facility failed to ensure appropriate indications and physician documentation for the continued use of antipsychotic medications in two residents with dementia. One resident had diagnoses of dementia, depression, and anxiety, with a Quarterly MDS showing severely impaired cognition and documentation of daily antipsychotic, antidepressant, anticonvulsant, and opioid use. The resident’s CAA noted daily antipsychotic use for dementia, and the care plan intervention was limited to administering medications as ordered. A physician order directed Zyprexa 5 mg twice daily via PEG tube or by mouth for combative behavior, hitting, and scratching. However, the clinical record lacked physician documentation of the risk versus benefit for this antipsychotic use with a non-approved indication in a resident with dementia, and the facility could not provide such documentation upon request. The only available consent form for psychoactive medication therapy did not include the required physician rationale or documentation of multiple unsuccessful nonpharmacological interventions. A second resident, also with diagnoses of dementia, depression, and anxiety and severely impaired cognition on the Quarterly MDS, was receiving hospice services and had received antipsychotic, antidepressant, antianxiety, and opioid medications. The CAA documented daily antipsychotic use for dementia, and the care plan intervention again only directed staff to administer medications as ordered. A physician order prescribed olanzapine 5 mg by mouth at bedtime for a psychotic disorder. Similar to the first resident, the clinical record for this resident lacked physician documentation of risk versus benefit for antipsychotic use with a non-approved indication in a resident with dementia, and the facility was unable to provide this documentation when requested. The consent form for psychoactive medication therapy for this resident also lacked the physician documentation supporting continued use with a non-approved indication, despite the facility’s policy stating that psychotropic drugs would only be used when necessary to treat specific indicated and effective conditions and not for staff discipline or convenience.
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