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.
Failure to Document Monitoring for Psychotropic Medications: A resident with CVA-related hemiplegia, bipolar disorder, anxiety, and depression received aripiprazole and fluoxetine, with orders for q shift behavior monitoring and side effect monitoring. The TAR showed multiple missed entries for antidepressant side effects, antipsychotic side effects, and behavior monitoring, and RN interviews confirmed the omissions while the resident was receiving the psychotropic medications.
Failure to document GDR or rationale for psychotropic use: A resident with generalized anxiety disorder, bipolar disorder, and depression was prescribed multiple psychoactive meds, including Benadryl, Divalproex, Meclizine, and Rexulti. A pharmacy consultant review asked the physician to indicate whether dose reduction was desired or provide a rationale for continued use, but the physician did not document a GDR attempt or a clinical rationale in the EHR, and the DON confirmed the form was not completed by the physician.
A facility failed to prevent unnecessary psychotropic use for several residents with cognitive impairment and psychiatric or neurologic diagnoses. PRN lorazepam orders were not limited to 14 days for two residents, and consultant pharmacist recommendations for GDRs and order clarification for other psychotropic medications were not addressed by the physician. Residents continued receiving lorazepam, antidepressants, anxiolytics, sedatives, and antipsychotics as ordered.
Failure to Limit PRN Psychotropic Medication Order: A resident with epilepsy, vascular dementia, schizophrenia, anxiety, and depression had an active PRN lorazepam order that remained on the eMAR beyond the 14-day limit for PRN psychotropic meds. The consultant noted the order required prescriber review to continue, but no current rationale or evaluation was documented, and the DON confirmed the resident had no behaviors or outbursts and the order had been overlooked.
Failure to Address Psychotropic Medication Gradual Dose Reduction: A resident with chronic respiratory failure, CHF, AFib, CVA, DM2 with neuropathy, repeated falls, schizoaffective disorder, and recurrent severe MDD had a BIMS score of 10 and was prescribed brexpiprazole 2 mg HS and sertraline 100 mg daily. A pharmacy consultant recommended review of the routine use of both psychotropic meds and requested a GDR or rationale for continued use, but the physician response remained blank and the DON acknowledged the recommendations had not been addressed timely.
A resident with dementia and mood disturbance had a PRN Vistaril order for anxiety and/or restlessness that had no stop date. The DON acknowledged the PRN psychotropic order remained active beyond 14 days and should have included an end date.
PRN Psychotropic Order Not Limited to 14 Days: A resident with multiple psychiatric and neurologic diagnoses had a PRN trazodone order for anxiety, depression, insomnia, and paranoia that had no end date. The record showed no prescriber rationale to extend the PRN psychotropic beyond the 14-day limit, and the DON confirmed the order was not limited to 14 days.
Failure to Document Clinical Rationale for Denied GDRs: The facility did not ensure the provider documented a handwritten, valid clinical rationale when declining pharmacy-recommended GDRs for multiple residents receiving psychotropic medications. Residents with diagnoses including bipolar disorder, dementia, schizoaffective disorder, depression, and anxiety were prescribed antipsychotic, antidepressant, antianxiety, and mood-stabilizing medications, but the NP only marked “NO” or “No” on the consultant reports without documenting why dose reduction was contraindicated or whether the minimal effective dose was being used.
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