|§483.45(e) Psychotropic Drugs. |
§483.45(c)(3) A psychotropic drug is any drug that affects brain activities associated with mental processes and behavior. These drugs include, but are not limited to, drugs in the following categories:
(iii) Anti-anxiety; and
Based on a comprehensive assessment of a resident, the facility must ensure that---
§483.45(e)(1) Residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record;
§483.45(e)(2) Residents who use psychotropic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs;
§483.45(e)(3) Residents do not receive psychotropic drugs pursuant to a PRN order unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record; and
§483.45(e)(4) PRN orders for psychotropic drugs are limited to 14 days. Except as provided in §483.45(e)(5), if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order.
§483.45(e)(5) PRN orders for anti-psychotic drugs are limited to 14 days and cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication.
Based on a review of facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that non-pharmacological behavioral interventions were attempted prior to the administration of anti-psychotic medications for one of 25 residents reviewed (Resident 26).
The facility's policy for "as needed" use of psychoactive medications such as an antianxiety, dated March 9, 2022, indicated that a psychoactive medication will be administered only as a last resort after at least three alternative methods/interventions have failed. If administered, the medication administration record is to be signed and a corresponding entry made on the behavior/intervention flow record.
A diagnosis record for Resident 26, dated January 26, 2022, included dementia, metastatic cancer (spread form the primary site to other areas) to the brain and Von Willebrand disease (blood clotting disorder).
A physician's progress note for Resident 26, dated April 25, 2022, indicated that she had anxiety and depression secondary to her dementia.
A physician's order for Resident 26, dated June 3, 2022, included an order for her to receive 0.5 milligrams (mg) of Ativan three times a day as needed for anxiety.
The medication administration record (MAR) for Resident 26 for June 2022, indicated that she received the Ativan on June 4, 2022, at 3:18 p.m. and June 5, 2022, at 10:44 a.m. The MAR documentation further indicated that she had no specific behaviors at that time. There was no documented evidence that there were non-pharmacological interventions attempted prior to the administration of Ativan on these dates.
Interview with the Nursing Home Administrator on June 7, 2022, at 10:47 a.m. confirmed that there was no documented evidence of a behavior and/or non medicinal interventions provided prior to the administration of Ativan on June 4, 2022, at 15:18 and on June 5, 2022, at 10:44 a.m. She further indicated that the staff are to give the medication for behaviors only when other interventions were not effective and to document on the record.
28 Pa. Code 211.12(d)(3) Nursing services.
28 Pa. Code 211.12(d)(5) Nursing services.
| ||Plan of Correction - To be completed: 07/12/2022|
1.A medication review was completed to determine continued use of the prn anti-anxiety medication. Based upon review of past and current behaviors it was determined to maintain prn use of medication after other interventions have been attempted and failed.
2.Upon review of physician orders, it was determined that Resident 26 is the only current resident to receive a prn anti-anxiety medication.
3.Mandatory education will be held to review the facilities Administration of Medications Policy & Procedures, providing at least (3) interventions and the importance of documenting those interventions prior to medication administration.
4.The Director Of Nursing or designee will conduct an audit at random weekly for 4 weeks. All findings of concern will be immediately addressed. The findings of this audit will be reported to the Quality Assurance Committee monthly for further review.
5.Date certain 7/12/22