PRN Lorazepam Order Lacked Required Stop Date and Rationale
Penalty
Summary
The deficiency involves the facility’s failure to ensure an as-needed psychotropic medication order for a resident included a required 14-day stop date or a specified duration with physician rationale for extended use. The resident had diagnoses of hypertension and diabetes mellitus and a BIMS score of zero, indicating severely impaired cognition, and required substantial to maximal assistance with all ADLs except eating. The MDS documented that the resident received an antidepressant, hypnotic, and antianxiety medication during the observation period. The Psychotropic Use CAA noted no adverse reactions to antidepressant treatment, and the care plan included goals for the resident to be free from medication side effects and symptoms related to black box warnings, with pharmacist consultation and education for the DPOA and the resident. Despite these care plan elements, the EMR orders showed lorazepam cream 0.5 mg to be applied every eight hours and as needed for dementia without a 14-day stop date or any specified duration. The EMR also lacked a physician’s rationale for the extended as-needed use of lorazepam. Nursing staff interviews confirmed that nurses taking orders were expected to inform physicians that as-needed lorazepam required a stop date and that the DON served as a second check for all orders. Administrative staff stated the facility’s policy was to follow regulations for as-needed psychotropic medications, but the facility did not provide an unnecessary psychotropic drug policy when requested by surveyors.
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