Failure to Ensure Diagnosed Indications and Time-Limited PRN Use for Psychotropic and Other Medications
Penalty
Summary
The deficiency involves the facility’s failure to ensure psychotropic and other medications were prescribed and documented as medically necessary to treat specific, diagnosed conditions, and to ensure PRN psychotropic medications were time-limited or had a documented duration. For one resident with multiple mental health diagnoses including unspecified mood disorder, generalized anxiety disorder, major depressive disorder, PTSD, and dementia, the record showed orders for divalproex sodium as a “mood stabilizer” and quetiapine fumarate for “mood disorder.” During interview, the DON confirmed that the stated indications of “mood stabilizer” and “mood disorder” were not supported by corresponding diagnoses in the clinical record and that these indications did not qualify as specific conditions for prescribing these medications, nor were the medications documented as treating specific diagnosed conditions. For another resident with peripheral vascular disease and extramedullary plasmacytoma, the record showed an order for aspirin with the indication “prophylactic measures” and an order for Bactrim DS with the indication “chemotherapy.” The DON confirmed that “prophylactic measures” is not a diagnosis and that the resident did not have a diagnosis for chemotherapy, and that these medications were not documented as treating specific diagnosed conditions. A third resident with dementia, anxiety, bipolar disorder, major depressive disorder, and seizure disorder had PRN orders for lorazepam for anxiety and temazepam for insomnia. The DON confirmed these PRN psychotropic medications did not have stop dates and lacked documentation of a rationale to extend their use beyond an initial limited period. The surveyors concluded these practices failed to prevent the use of unnecessary psychotropic medications and did not comply with requirements for PRN psychotropic orders.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.