Three residents were prescribed psychotropic medications without periodic assessment, documentation of nonpharmacological interventions, or identification and tracking of targeted behaviors. One resident received duplicate antipsychotic therapy without justification, and in all cases, required documentation and behavioral tracking were missing, as confirmed by the DON and corporate nurse consultant.
A resident with severe cognitive impairment was prescribed and administered Remeron for depression without obtaining informed consent beforehand. The facility's policy requires informed consent prior to prescribing psychotropic medications, but consent was only obtained verbally after the medication had been administered for several weeks.
The facility failed to justify the use of psychotropic medications for several residents and did not attempt a Gradual Dose Reduction (GDR) for a resident, despite policy requirements. One resident was on Quetiapine without documented behaviors necessitating its use, while another resident's care plan lacked specific behaviors justifying antipsychotic medication. Additionally, a resident on Venlafaxine and Aripiprazole had no documented harmful behaviors, yet no GDR was attempted. The facility's Director of Nursing confirmed the lack of documentation for GDR attempts.
The facility failed to address a gradual dose reduction for a resident on buspirone and did not ensure a stop date for a PRN anti-anxiety medication for another resident. The DON and MDS Coordinator did not follow up on the dose reduction, and the PRN order lacked the required 14-day stop date.
A resident was prescribed Seroquel for mood disorder related to Vascular Dementia without documented behaviors justifying its use. Despite the facility's policy requiring psychotropic drugs only when necessary, the resident showed no aggressive behaviors, and the DON was unsure of antipsychotic regulations.
A resident was found to be receiving unnecessary psychotropic medications without documented gradual dose reductions or non-pharmacological interventions. The resident exhibited sedation and lethargy, with no documented behaviors justifying the medication use. The facility's psychiatric provider and pharmacy consultant acknowledged the inappropriate use of QUEtiapine for dementia-related behaviors, but the medication was not discontinued despite recommendations.
A facility failed to perform a quarterly gradual dose reduction (GDR) evaluation for a resident on psychotropic medications, as required by their policy. The resident, with a history of cognitive and anxiety disorders, was receiving Trazodone and Depakote daily without a documented GDR assessment. The DON confirmed that GDRs should occur during quarterly reviews, but only one psychiatric progress note was available, lacking a GDR assessment.
A facility failed to include a stop date in a psychotropic medication order for a resident with generalized anxiety disorder. The order for Lorazepam Oral Concentrate did not specify a duration, contrary to the facility's policy requiring PRN orders to be limited to 14 days. This was confirmed by the administrator.
A facility failed to document a clinical rationale for extending a PRN psychotropic medication order for a resident. The policy requires PRN orders to be limited to 14 days unless a rationale is documented. A resident had an order for Alprazolam for 30 days without a documented rationale. An LPN confirmed the extension was made without written justification.
A resident with Dementia was prescribed Quetiapine/Seroquel without appropriate indication, as required by facility policy. Despite the medication, the resident's behavior of constant yelling was not reduced, and the dosage was acknowledged to be higher than usual. Observations confirmed the resident's frequent calls for help, indicating insufficient use of non-pharmacological interventions.
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