PRN Antipsychotic Order Not Limited or Reassessed: A resident with advanced dementia, Alzheimer’s disease, agitation, and hospice services received PRN haloperidol for agitation and delirium under an open-ended order rather than a 14-day limit. Physician documentation continued the medication but did not show an evaluation of its ongoing need or an adequate rationale for renewal, and nursing notes did not document non-pharmacological interventions before one PRN dose was given.
A resident with dementia, Parkinson’s disease, and behavioral symptoms had PRN olanzapine ordered for severe agitation with an open-ended end date and no documented 14-day prescriber evaluation. The med had been discontinued for nonuse after the resident remained stable, then later restarted at the family’s request despite no recent anger outbursts and without adequate clinical justification documented for the renewed PRN antipsychotic use.
PRN psychotropic medication orders for a resident with emphysema, depression, panic disorder, PTSD, and anxiety lacked stop dates, specific durations, and documented prescriber rationale for use beyond 14 days. The resident had orders for olanzapine, trazodone, and hydroxyzine PRN, and RN and DON interviews confirmed the orders did not include required end dates per facility policy.
PRN psychotropic medication was ordered for a resident with severe cognitive impairment, hospice services, and multiple diagnoses, including Alzheimer's disease, depression, and psychotic disorder, but the record lacked the required provider rationale for extending the PRN lorazepam order beyond the 14-day limit. The MAR showed no doses were administered during the reviewed period, and both the DCS and DON stated PRN psychotropic orders are initially limited to 14 days unless the prescriber documents justification for a longer duration.
The facility failed to complete ordered orthostatic BP monitoring for a resident receiving risperidone. The resident had dementia, bipolar disorder, sleep apnea, hyperlipidemia, and insomnia, and monthly lying, sitting, and standing BPs were ordered due to antipsychotic use. EMR review showed the same BP value was documented for all three positions each month, and an RN and the DON stated the readings were not being obtained in succession as expected.
A resident with dementia and severely impaired cognition received olanzapine, but the chart contained conflicting documentation about the indication for use. Pharmacy notes described the medication as being used for dementia-related agitation and referenced adding schizophrenia to the diagnosis list, while the care plan and nursing notes lacked documentation of schizophrenia. Interviews showed the DON did not know the basis for the diagnosis, and the former MD stated the resident was being treated for vascular dementia and did not have schizophrenia.
Failure to document GDR or rationale for psychotropic use: A resident with dementia, TBI, anxiety, and depression was receiving escitalopram and quetiapine, with no behaviors noted during the assessment period. Pharmacy recommended review of continued use and a clinical rationale if doses were maintained, but the record did not show a GDR attempt or documented rationale for not completing one; the DON stated that documenting the resident as stable was not an appropriate rationale.
PRN antipsychotic order lacked required stop date. A resident with severe cognitive impairment, dementia, anxiety, depression, wandering, and behavioral symptoms received PRN Haloperidol repeatedly, but the order was entered as indefinite even though it was written for 14 days. Staff said the medication was used when redirection failed and behaviors disturbed others, and the LPN, RN, and DON confirmed PRN psychotropic meds should have an end date and be re-evaluated after 14 days.
Failure to review a resident’s PRN psychotropic medication every 14 days. A resident with diagnoses including suicidal ideations, GAD, and MDD received Hydroxyzine PRN multiple times, but physician encounter notes did not address renewal or discontinuation at the required review interval. The pharmacist later noted the order was overdue for review, and facility staff confirmed the medication had been given beyond the 14-day mark without a documented stop date or provider review.
PRN psychotropic medication was left active beyond the required 14-day limit for a resident with moderately impaired cognition, depression, and chronic pain. The resident had a PRN lorazepam order for anxiety/restlessness that lacked a stop date, and the EHR did not include a provider rationale for continued use beyond 14 days. The RNCM and DON reviewed the record and confirmed the order should have had a 14-day stop date unless hospice criteria applied.
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