|§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 review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to ensure one of 3 residents reviewed were free of unnecessary psychotropic medications (Resident 2 ).
Review of the facility policy, Antipsychotic Medication Use, revised December 2016, revealed "residents will not receive PRN (Pro Re Nata, as needed) doses of psychotropic medications unless that medication is necessary to treat a specific condition that is documented in the clinical record."
Review of Resident 2's clinical record revealed diagnoses that included: depression (feelings of severe despondency and dejection), dementia (a chronic disorder of the mental processes caused by brain disease, and marked by memory disorders, personality changes, and impaired reasoning), anxiety (a feeling of worry, nervousness, or unease), and aphasia (loss of the ability to understand or express speech).
Review of Resident 2's clinical record revealed a physician's order for as needed Ativan 0.5mg (milligrams, a unit of measure) every 6 hours as needed for anxiety/depression, with a start date of November 28, 2019.
Review of Resident 2's December 2019, Medication Administration Record (MAR, a record of medications that were administered) revealed Resident 2 had received one dose of the aforementioned medication on the following dates in December 2019: 1st, 2nd, 3rd 4th 5th, two doses on the 7th, two doses on the 8th, 10th, 11th, 14, 15th, 16th, two doses on the 20th, 21st, 23rd, and 29th.
Further review of Resident 2's clinical record failed to reveal behaviors or non-pharmacological interventions to minimize behaviors on the following dates in December 2019: 3rd, 4th, 5th and the 11th.
28 Pa Code 211.12(d)(1)(3)(5) Nursing services.
| ||Plan of Correction - To be completed: 02/06/2020|
1. How facility will correct the deficiency as relates to individual.
The nursing staff that failed to document behaviors and/or non-pharmacological interventions identified in Resident 2's record have been educated on the documentation requirements prior to the administration of Resident 2's PRN medication.
2. How facility will act to protect residents in similar situations
The DON/designee will complete a whole house audit of the Medication Administration Records and identify residents with orders for PRN psychotropic medications to ensure they have proper documentation for behavior and non-pharmacologic interventions prior to medication.
3. Measures the facility will take or systems it will alter to ensure that the problem does not recur.
Licensed nursing staff were educated by the DON/designee on the documentation requirements prior to the administration of PRN medication.
4. How the facility plans to monitor its performance to make sure that solutions are permanent. ; i.e. what quality assurance programs will be established?
DON/designee will audit administered psychotropic PRN's for appropriate behaviors and non-pharm documentation weekly times four and monthly times three to monitor performance and make sure the solutions are permanent.
Results of the audit will be reported monthly to the QAPI Committee by the DON/designee to track compliance and/or modification to the system.