A resident admitted for hospice care with dementia and Parkinson's disease was prescribed lorazepam and quetiapine for anxiety and psychosis, but staff did not initiate monitoring for targeted behaviors or medication side effects until two days after starting the medications. Nursing staff and leadership confirmed that monitoring should have begun with the initiation of psychotropic medications, as required by facility policy.
A resident with severe cognitive impairment and multiple psychiatric diagnoses received a PRN order for Ativan that was not limited to 14 days, as required by regulation and facility policy. The order lacked both an end date and documented rationale for extension, and this oversight was confirmed by the DON during record review.
A resident with severe cognitive impairment and major depressive disorder was prescribed mirtazapine, but the required informed consent documentation was incomplete, lacking a physician's signature and proper witness dating. Facility staff confirmed that this did not meet policy requirements for informed consent prior to administering psychotropic medication.
A resident was prescribed an anti-anxiety medication without first attempting non-pharmacologic interventions or monitoring for side effects and adverse drug reactions. Facility staff confirmed the importance of these steps, but the resident's records showed no evidence of such actions.
The facility failed to ensure two residents were free from unnecessary antipsychotic medications. One resident continued PRN Seroquel beyond 14 days without reevaluation, and another resident lacked behavioral monitoring for Seroquel use. The facility's policy requires non-pharmacological interventions and behavioral monitoring for residents on psychotropic medications, which were not followed.
A facility failed to ensure a resident was not prescribed Seroquel without an appropriate diagnosis, as the resident's records did not support a mental illness diagnosis. Additionally, the facility did not define or monitor behaviors related to lorazepam use for another resident, failing to document the resident's response to the medication. The Director of Nursing acknowledged these deficiencies, which contravened the facility's policy on psychotropic medication management.
Two residents receiving PRN lorazepam for anxiety were not reevaluated after 14 days, contrary to facility policy. Both residents had severely impaired cognitive skills and required significant assistance from staff. The DON confirmed the absence of a stop date and reevaluation, which could lead to unnecessary medication use.
A facility failed to ensure a resident's PRN psychotropic medication, Seroquel, had a 14-day administration limit, as required by policy. The resident, with schizophrenia and major depressive disorder, was prescribed Seroquel without the necessary stop date, increasing the risk to their mental well-being. The facility's Psychiatrist did not order the medication, and the Director of Nursing and Pharmacy Consultant acknowledged the oversight.
The facility failed to ensure appropriate use of psychotropic medications for several residents, including administering lorazepam without proper documentation, prescribing mirtazapine and divalproex without specific target behaviors, and administering sertraline and divalproex sodium without informed consent. Additionally, alprazolam was prescribed PRN without a stop date, leading to potential unnecessary medication use.
The facility failed to ensure nonpharmacological interventions were attempted before administering PRN lorazepam to a resident with anxiety disorder, as documented in their medication administration record. Additionally, another resident's PRN lorazepam order lacked a stop date, contrary to facility policy requiring a 14-day limit. These deficiencies were confirmed through interviews and record reviews.
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