Failure to Implement Required Stop Orders for PRN Antianxiety Medication
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident receiving PRN antianxiety medication had appropriate stop orders in place, as required by facility policy. The resident had diagnoses including late-onset Alzheimer’s disease, pain, anxiety, severe cognitive impairment, delusions, and behavioral symptoms such as paranoia and agitation. The resident’s admission MDS documented severe cognitive impairment and behavioral symptoms, and the Behavioral Symptom CAA noted multiple episodes of paranoia and agitation, leading to an increased dose of Seroquel and lorazepam 1 mg PRN every four hours for anxiety. The care plan documented severely impaired cognition, depression, and use of antidepressant and antipsychotic medications for anxiety and paranoid thoughts, with interventions such as redirection and monitoring for worsening depression. Physician orders dated 01/30/26 and 03/27/26 directed staff to administer lorazepam 1 mg every four hours PRN for restlessness/agitation and topical lorazepam 2 mg/ml every four hours PRN if the oral dose was refused, both without stop dates. Another order dated 02/19/26 directed scheduled lorazepam 1 mg in the afternoon for anxiety disorder. The consultant pharmacist’s review on 02/09/26 recommended a stop date or GDR for the anxiolytic, but the physician declined, stating the resident was on hospice and receiving palliative care, without specifying a duration for continued PRN use. The administrative nurse responsible for monitoring psychotropic use confirmed that the physician had declined a stop date and was unsure about the need for a stop order for palliative residents. This was inconsistent with the facility’s Unnecessary Drugs and Psychotropic Drugs policy, which required limiting PRN psychotropic medications (other than antipsychotics) to 14 days unless a longer timeframe was deemed appropriate by the prescriber, thereby resulting in the cited deficiency.
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