Unnecessary Psychotropic Medication Not Evaluated: A resident with dementia, chronic lung disease, depression, and HTN was ordered risperidone for unspecified dementia without behavioral, psychological, mood, or anxiety disturbance. The record did not show that the attending physician or prescribing practitioner evaluated the medication’s appropriateness, and the ADON confirmed the facility failed to ensure the resident’s med regimen was free from unnecessary psychotropic medication.
Psychotropic medication management was deficient for two residents. One resident had a PRN Ativan order for anxiety with no end date shown on the MAR, and another resident with dementia, anxiety, psychosis, and major depressive disorder had ongoing orders for Quetiapine and Escitalopram with MRRs noting the meds were due for CMS psychopharmacologic review and GDR assessment, but no physician response or signature was documented.
A resident with schizoaffective disorder, bipolar type, depression, anxiety, and other mental health diagnoses was prescribed multiple psychotropic meds, including an antipsychotic, antidepressants, an anxiolytic, and a mood stabilizer. The record showed limited behavior tracking only for the antipsychotic, with no ongoing target behavior or side effect monitoring documented for the antidepressant and anxiolytic meds. Consultant pharmacist requests for semi-annual psychotropic review were deferred to psychiatry, but the psychiatry provider did not document a response to those recommendations, and a later pharmacist review was also not addressed in the psychiatry note.
A resident with CHF and intact cognition received PRN Alprazolam for anxiety on four occasions, but the clinical record did not document any individualized non-pharmacological interventions attempted or found ineffective before the doses were given. The DON and NHA confirmed the record lacked this documentation, and the facility policy required monitoring and documentation of both pharmacological and non-pharmacological interventions for psychoactive medication use.
A resident with cognitive impairment, dementia, anxiety, depression, and behaviors of rejecting care and wandering received psychotropic meds that were not transcribed as ordered. The MAR reflected that an olanzapine taper was entered incorrectly, so the resident received more olanzapine than intended while also receiving haloperidol TID, and the ADON confirmed the taper was not followed as ordered.
Unnecessary Psychotropic Medication Use: The facility failed to ensure that two residents’ medication regimens were free from unnecessary psychotropic medications. One resident received PRN lorazepam beyond the 14-day limit without a documented rationale for extending the order, and another resident’s record lacked documentation of non-pharmacological interventions, medication effectiveness, and side effect or behavior monitoring for prescribed psychotropics.
A resident with depression, anxiety, and moderate cognitive impairment received PRN Hydroxyzine on multiple occasions, but the record did not show that individualized non-pharmacological interventions were tried or ineffective before administration. The chart also lacked the prescriber’s clinical rationale and duration for continuing the PRN psychotropic order beyond the 14-day limit.
PRN psychotropic medication was used without the required clinical rationale for continued use beyond 14 days and without documentation of non-pharmacological interventions before administration. A resident with dementia, delusional disorder, and diabetes had a PRN Lorazepam order for anxiety, and the MAR showed the medication was given twice without evidence of prior non-medication interventions; the DON and ADON confirmed the missing stop date and lack of supporting rationale.
Failure to Attempt Non-Pharmacological Interventions Before PRN Lorazepam: A resident with neurocognitive disorder with Lewy bodies, CVA, and insomnia was cognitively impaired and had behaviors related to poor impulse control. Staff administered PRN lorazepam multiple times for agitation, but there was no documented evidence that non-pharmacological interventions were attempted first, and the ADON confirmed this in interview.
A resident received Lorazepam for anxiety and Duloxetine for depression, but the facility did not show adequate support for continued psychotropic use. The care plan called for monitoring target behaviors and depressive symptoms, yet the MAR/TAR reflected only one behavior being tracked, and the consultant pharmacist’s request to consider GDR or discontinuation was answered only with “medically stable.” The DON and NHA confirmed there was no evidence of the required behavior monitoring or other rationale supporting the ongoing regimen.
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