Unnecessary Medications and Inadequate Psychotropic Monitoring
Penalty
Summary
The deficiency involves the facility’s failure to ensure that residents’ drug regimens were free from unnecessary drugs by not aligning indications for use with current diagnoses and by not consistently monitoring psychotropic medications. For multiple residents, physician orders listed indications such as restless leg syndrome (RLS), gout, seizures, neuropathy pain, opioid use disorder, muscle stiffness/tremors, aggressive behaviors, agitation, and insomnia, but the corresponding diagnoses were not present in the medical record. The DON confirmed in interviews that medications should be documented to treat specific diagnosed conditions and that this was not done for these residents. One resident was prescribed ropinirole for RLS without having an RLS diagnosis. Another resident with diagnoses including DM2, depression, hyperlipidemia, insomnia, HTN, and CKD had orders for allopurinol for gout and Keppra for seizures, yet there were no diagnoses of gout or seizures in the record. A different resident with ESRD, adult failure to thrive, anxiety disorder, depression, and opioid dependence was ordered gabapentin for neuropathy pain without a neuropathy diagnosis, and torsemide with an indication of “diuretic therapy,” which the DON stated was not an appropriate indication of use. Additional residents were affected by similar issues. One resident with multiple psychiatric and infectious diagnoses, including schizophrenia, bipolar disorder, bacteremia, syphilis, and substance use, was ordered Suboxone for opioid use disorder, methocarbamol for “muscle relaxer,” and benztropine for stiffness/tremors, but did not have diagnoses of opioid use disorder or stiffness/tremors, and “muscle relaxer” was not considered an appropriate indication. Another resident with insomnia, depression, bipolar disorder, and generalized anxiety disorder was prescribed risperidone for aggressive behaviors without a diagnosis of aggressive behaviors. A resident with dementia with behavioral disturbance and major depressive disorder received melatonin for agitation and risperidone for unspecified dementia; the DON confirmed the resident did not have diagnoses of agitation or insomnia, and there was no order for monitoring risperidone side effects or tracking hours of sleep to justify continued melatonin use. For a resident with gangrene, frostbite with tissue necrosis, need for assistance with personal care, and schizophrenia, orders were in place for sertraline for depression and olanzapine for schizophrenia, along with orders for behavior monitoring due to antidepressant use and for antipsychotic side-effect monitoring. However, the MAR showed that while sertraline and olanzapine were administered, there was no documented monitoring for antidepressant side effects or psychotic behaviors during the review period. The DON confirmed that this resident did not have behavior monitoring for the antipsychotic and did not have side-effect monitoring for the antidepressant, and stated that this did not meet her expectations because psychotropic medications should be monitored for behaviors and side effects while residents are taking them. According to the report, this deficient practice could likely lead to adverse drug effects and poor patient outcomes.
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