§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:
(i) Anti-psychotic;
(ii) Anti-depressant;
(iii) Anti-anxiety; and
(iv) Hypnotic
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.
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Observations:
Based on review of facility policy and clinical records, and staff interviews, it was determined that the facility failed to provide a clinical rationale and duration for the continued use of a PRN (as needed) psychotropic (affecting the mind) medication beyond 14 days for one of five residents reviewed for psychotropic medications (Resident R6).
Findings include:
A facility policy entitled " Antipsychotic Medication Use" dated 3/28/2024, indicated that "PRN orders for psychotropic medications are limited to 14 days" and "If the prescriber or attending physician believes it is appropriate to extend the PRN order beyond 14 days, he or she will document the rationale for extending the use and include the duration for the PRN order."
Resident R6's clinical record revealed an admission date of 5/18/17, with diagnoses that included chronic obstructive pulmonary disease (when your lungs do not have adequate air flow), anxiety (a condition that causes a person to be nervous, uneasy, or worried about something or someone), and heart failure (a condition where the heart cannot supply the body with enough blood).
Review of Resident R6's Medication Administration Record (MAR) revealed a physician's order dated 7/9/24, to administer Vistaril (anti-anxiety medication) 25 milligrams (mg) every eight hours as needed (PRN) for 14 days. Further review of Resident R6's MAR revealed PRN Vistaril order was revised on 7/16/24, 7/17/24, and 7/18/24. After the revision on 7/18/24, the PRN Vistaril order lacked evidence of a specified duration. Resident R6 received PRN Vistaril on 7/16/24, 7/17/24, 7/18/24, 7/19/24, 7/23/24 and 7/24/24, which was beyond 14 days from the original order date. Resident R6's Vistaril order lacked the required stop date within 14 days and a clinical rationale for continued use beyond 14 days.
During interview on 7/25/24, at 9:25 a.m. the Director of Nursing revealed he/she was provided information that the PRN Vistaril did not need a duration to continue use, he/she confirmed that the information was incorrect. He/she also confirmed that the PRN Vistaril lacked the required stop date within 14 days and a clinical rationale for continued use beyond 14 days.
28 Pa. Code 211.10(d) Resident care policies
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services
| | Plan of Correction - To be completed: 08/29/2024
F0758
Resident R6's physician order was updated to include a fourteen (14) day stop date and Nonpharmacological Interventions.
A14 day look back audit was conducted on 07/26/2024 to identify other residents receiving psychotropic medications to ensure proper orders are in place.
The Director of Nursing/or designee will reeducate Licensed staff on psychotropic medications requiring a fourteen (14) day stop date and Non pharmacological interventions.
Audits will be conducted by the Social Worker or designee on all residents currently on psychotropic medications and new orders received for the categories under the classification of medications to ensure proper diagnosis and, fourteen (14) stop date orders and Non pharmacological Interventions are in place. Audits will be completed daily for 2 weeks and twice a week until compliance is achieved. Results of the audits will be reviewed at monthly QAPI meetings.
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