|§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 facility policy and clinical record review and staff interview, it was determined that the facility failed to limit PRN (as needed) anti-psychotic drug use for one of 8 residents (Residents R44).
A review of the facility policy "Medication, Treatment, Orders" dated June 2019, indicated that all orders for medications must include: the name and strength of the drug, the number of doses, a start and stop date and/or specific duration of therapy, dosage and frequency of administration and the route of administration.
A review of the clinical record revealed that Resident R44 was admitted to the facility on 10/2/18, and Minimum Data Set (MDS-periodic assessment of care needs) dated 7/11/19, included diagnoses of high blood pressure, dementia with behavioral disturbance, depression, anxiety disorder and insomnia.
A review of the clinical record revealed Resident R44's physician orders for as needed Ativan (an antianxiety medication) as follows:
On 5/16/19, Ativan 0.5 mg every day as needed.
On 6/25/19, Ativan 0.5 mg orally twice a day as needed for anxiety.
On 7/19/19, Ativan 0.5 mg every day as needed for anxiety.
On 9/25/19, Ativan 0.25 mg orally twice a day as needed for anxiety.
During an interview on 9/26/19, at 2:00 p.m. Registered Nurse Employee E7 confirmed that the facility failed to indicate a stop date for Resident R44's PRN Ativan as required.
28 Pa. Code: 211.12(d)(1)(5) Nursing services.
| ||Plan of Correction - To be completed: 11/18/2019|
R44-was not affected by this deficient practice. She was reviewed on 3/29 at the psychotropic interdisciplinary meeting.
The facility has determined all residents have the potential to be affected. The Physician will be involved to review for continued use of this medication. Charts of residents receiving PRN psychotropic medications will be reviewed to ensure they have the proper stop date and documentation. Residents that are found to have orders that are out of compliance lacking a stop date will have their attending Physician notified and a new order will be obtained that includes a stop date.
The DON or designee will educate staff on the facility policy "Medication Treatment Order" and the need for a 14 day stop date on PRN psychotropic medications.
The Director of Nursing Services or designee, will audit charts of residents that are ordered PRN psychotropic medications to assure orders include a 14 day stop date. for compliance with 14 day limit, 5 times a week for 2 weeks, 3 times a week for 2 weeks, weekly for 2 weeks. Random chart audits will occur until substantial compliance is achieved.
The results of the Audit will be shared with the Administrator, Medical Director and at the Quality Assurance Performance Improvement Committee meeting.