Inappropriate Antipsychotic Use Without Proper Diagnosis
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident’s right to be free from chemical restraints not required to treat medical symptoms, specifically through the use of the antipsychotic medication Quetiapine (Seroquel) without an appropriate diagnosis. A female resident with Alzheimer’s disease, vascular dementia, and a history of stroke was admitted with these conditions documented on her face sheet. Physician orders showed Quetiapine 50 mg at bedtime for “vascular dementia with agitation,” later increased to two 50 mg tablets at bedtime for the same indication. The MAR confirmed that the resident received Quetiapine 50 mg nightly over multiple days, including after the dose increase. During interviews, the Interim DON and the CCN both stated that “vascular dementia with agitation” was not an appropriate diagnosis to justify the use of Quetiapine and acknowledged that the medication could cause oversedation in elderly residents. The CCN reported that the Hospice nurse had obtained the order for Quetiapine. Review of the facility’s Antipsychotic Medication Use policy, revised March 2025, showed that antipsychotics were to be used only when necessary to treat specific indicated conditions, generally limited to diagnoses such as schizophrenia, schizoaffective disorder, delusional disorder, mood disorders, psychosis, and in the absence of dementia, and that they should be prescribed at the lowest possible dose for the shortest period of time. The resident’s use of Quetiapine for vascular dementia with agitation did not align with these stated indications, resulting in the cited deficiency.
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