A resident with moderate cognitive impairment was receiving a daily antidepressant (fluoxetine 10 mg) under a physician’s order, and the care plan directed staff to monitor and document medication side effects and effectiveness. Facility policy required proactive monitoring and documentation of side effects for all medications, including psychotropics. However, review of the treatment administration record over several months showed no documentation of side effect monitoring for this resident, and the DON confirmed that no such monitoring had occurred, despite many residents in the facility receiving psychotropic medications.
A resident received quetiapine for vascular dementia with agitation despite a facility policy that did not permit antipsychotic use for any form of dementia. Physician orders directed scheduled morning and bedtime doses, and the MAR showed the medication was administered on multiple consecutive days. The DON confirmed antipsychotics were not approved under the policy for dementia, while an LPN reported giving quetiapine for the resident’s aggression but did not know whether it was an approved treatment indication. The DON also noted that multiple residents in the facility were receiving antipsychotic medications.
A resident with dementia and anxiety received four extra doses of hydroxyzine after an agency LPN entered an order for three times daily dosing, despite the physician's directive to reduce the dose to twice daily. The LPN made this change without proper verification, resulting in the resident receiving unnecessary medication until the error was identified by an RN.
Two residents were prescribed and administered Seroquel for dementia-related diagnoses, contrary to facility policy that restricts antipsychotic use to specific, indicated conditions. An LPN reported the medication was used for behavioral issues, while the DON confirmed antipsychotics are not approved for dementia treatment. Despite this, multiple residents were receiving these medications for dementia.
A resident with dementia, anxiety disorder, and PTSD was administered both 1 mg and 0.5 mg doses of Risperdal after a dose reduction order was written but the original higher dose was not discontinued. The resident did not understand why the medication was being given and expressed a desire not to take it. The DON confirmed the unnecessary administration resulted from a failure to discontinue the previous order.
A resident was prescribed and administered Seroquel, an antipsychotic, for unspecified dementia with behavioral disturbances and anxiety, despite facility policy requiring antipsychotics only for specific, indicated conditions. Staff interviews confirmed the medication was used for dementia-related behaviors, and the DON acknowledged it was not approved for this diagnosis, resulting in a deficiency for unnecessary medication use.
A resident with anxiety disorder and depression had a PRN order for Ativan 0.5 mg every 12 hours for anxiety that lacked an end date and was not limited to 14 days as required by facility policy. A pharmacy consultant identified the PRN psychoactive medication as potentially constituting a chemical restraint and requested physician documentation of rationale and a specific duration for any extension, but the physician chose to keep the PRN order without providing the required handwritten rationale or duration. A quarterly assessment showed the resident had intact cognition and was receiving an antianxiety medication, while an LPN and the DON both acknowledged that PRN psychotropic medications should be time-limited to two weeks unless a physician documents justification and duration, demonstrating noncompliance with the facility’s own standards.
A resident prescribed haloperidol for delusional and anxiety disorders did not have required side effect monitoring documented on the treatment administration record, despite facility policy and care plan directives. The DON confirmed that monitoring should occur every shift and be recorded, but no such documentation was found.
The facility did not consistently monitor or document side effects and behaviors for residents on psychotropic medications, and failed to ensure PRN psychotropic orders were limited to 14 days with physician re-evaluation. Staff interviews revealed inconsistent practices and a lack of clarity regarding monitoring requirements, leading to gaps in compliance with medication safety protocols.
A resident diagnosed with dementia without behavioral disturbances was prescribed sertraline, an antidepressant, for dementia. Facility policy required clear documentation of the indication for psychotropic medications, but staff interviews revealed uncertainty about the specific symptoms being treated and whether sertraline was appropriate for dementia. The pharmacist and nurse practitioner confirmed that sertraline is not approved for dementia, and the DON was unsure about its approved uses.
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