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 multiple psychiatric diagnoses and moderate cognitive impairment continued to receive several psychotropic medications without evidence that pharmacy requests for gradual dose reduction (GDR) were addressed by the physician. Additionally, recommendations from a Psych NP to decrease the dosage of one medication were not communicated to the physician, and no physician response was documented.
The facility did not ensure that PRN psychotropic medication orders were limited to 14 days or that appropriate physician documentation was provided for continued use. Several residents received ongoing PRN psychotropic medications without required reassessment or rationale, and one resident was given a psychotropic drug for staff convenience to manage combative behavior. Staff interviews revealed a lack of awareness of the 14-day reassessment requirement.
Two residents receiving psychotropic medications did not have their gradual dose reduction (GDR) forms reviewed by a physician as required. One resident with dementia and multiple psychiatric diagnoses had GDR forms for several medications left unaddressed, while another resident on hospice with psychiatric and neurological conditions also had GDR forms for multiple medications that were not reviewed. The administrator confirmed the lack of physician documentation for these GDRs.
Two residents with intact cognition were prescribed as-needed Klonopin for longer than 14 days without a specified stop date, despite pharmacist requests for clarification. The DON confirmed that the physician did not address the recommendations, resulting in continued use of psychotropic medications beyond the recommended duration.
A resident with schizophrenia and intact cognition was prescribed Risperdal 1mg twice daily, but there was no evidence that a gradual dose reduction was attempted or that a clinical contraindication was documented. Despite a consultant pharmacist's recommendation for a dose reduction, the physician did not provide a documented response, and the medical record lacked required documentation regarding the use of the antipsychotic medication.
A resident with severe cognitive impairment and multiple medical conditions was prescribed antipsychotic and antianxiety medications, but staff failed to document monitoring for side effects and behaviors as required by the care plan. Review of medication records and staff interviews confirmed the absence of this monitoring over several weeks.
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