A resident with dementia, depression, and severe cognitive impairment received PRN Ativan for target behaviors, but the order had no stop date despite the facility policy limiting PRN psychotropics to 14 days unless the practitioner documents the rationale for extension. The MAR and progress notes also lacked documentation of the behaviors supporting several Ativan administrations, and the DON confirmed no behaviors were observed or documented for those doses.
A resident with unspecified dementia, anxiety, and recurrent major depressive disorder had a BIMS score indicating moderate cognitive impairment and was receiving Abilify. The S3ADON confirmed the medication was an antipsychotic and that the resident did not have an appropriate diagnosis to support its use.
A resident with generalized anxiety and bipolar disorder had a PRN lorazepam order for anxiety and restlessness that lacked a stop date and did not include a documented rationale for use beyond 14 days. The DON confirmed the order had no stop date and no documented rationale for continued PRN use.
Unnecessary psychotropic medication use was not ensured for 3 residents. One resident with Parkinson's disease, MDD, and dementia had a Seroquel GDR recommendation that was not implemented, and three residents had PRN psychotropic orders that continued beyond 14 days without a documented rationale or stop date. The DON confirmed the missing GDR documentation and extended PRN orders.
PRN psychotropic use was not properly limited for a resident with depression, anxiety, and dementia. The resident had an order for PRN Ativan via PEG tube for agitation, but the consultant noted the order needed a prescriber review after 14 days and required documentation of the rationale and a specific duration. The record lacked that documentation, and the DON confirmed there was no documented rationale or duration for the PRN Ativan order.
Incomplete GDR for Psychotropic Medications: A resident with Parkinson's disease, Alzheimer's disease, depression, anxiety, and delusional disorder was receiving multiple psychotropic meds, including haloperidol, lorazepam, quetiapine, and sertraline. The resident's GDR did not show review of these meds for an attempted dose reduction, did not include a rationale for continuing them at the current dose, and left diagnosis fields blank for haloperidol and quetiapine; the DON acknowledged the GDR was not completed and not signed by a physician.
Delayed GDR for antipsychotic medication. A resident with anxiety disorder, depressive episodes, psychotic disturbance, and moderate cognitive impairment was receiving an antipsychotic. The pharmacist recommended reducing the nightly Seroquel dose, and the MD agreed, but there was a 2-month delay in completing the GDR process, which the DON confirmed should not have occurred.
PRN psychotropic medication orders were left active beyond the 14-day limit for two residents. One resident with intact cognition had a PRN Hydroxyzine order for anxiety with no stop date, and another resident with intact cognition and Parkinson’s disease had a PRN Lorazepam order for anxiety that remained active and was documented as administered on the MAR. The DON confirmed both orders exceeded the 14-day limit.
A resident with hemiplegia, diabetes, hypertension, late syphilis, and unspecified dementia with behavioral symptoms had a PRN order for Oxazepam 15 mg at night for insomnia written without a discontinue date. Pharmacy consultant review noted that PRN psychotropic medications must be limited to 14 days, with prescriber evaluation, documented rationale, and a specific duration if extended. The physician did not specify a duration for this PRN psychotropic order, and the DON confirmed the absence of a defined time limit, resulting in noncompliance with requirements to prevent unnecessary psychotropic use and chemical restraint.
A resident with severe cognitive impairment received Seroquel without a documented supporting diagnosis in the chart, and the MDS noted antipsychotic use with no indication. The care plan called for psychotropic medication monitoring every shift, but the facility did not monitor for side effects or behaviors, and internal medication review documents flagged the lack of a supporting diagnosis for the Seroquel order.
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