Health inspection·October 27, 2022

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of facility policy, the facility failed ensure a resident was free from unnecessary psychotropic medications by ensuring staff documented justification for an increase in a resident's antipsychotic medication. This affected one (#117) of five reviewed for unnecessary medications. The census was 239. Findings include: Review of Resident #117's medical record revealed an admission date of 03/06/20. Diagnoses listed included cerebral atherosclerosis, heart failure, restlessness and agitation, depression, and dementia with agitation. Review of an annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #117's brief interview for mental status (BIMS) score was 12, indicating the resident had moderate cognitive impairment. Resident #117 was assessed as not having any psychotic disorders. Review of physician orders revealed an order to increase the antipsychotic medication Seroquel from 25 milligrams (mg) twice a day to 50 mg twice a day (BID) by mouth (PO) dated 04/15/22 for unspecified dementia with behavioral disturbance. Resident #117 remained on Seroquel 50 mg PO BID with an order dated 09/10/22. Review of social services progress notes dated 03/14/22 revealed Licensed Social Worker (LSW) met with Resident #117's daughter via telephone. Resident #117 was adjusting favorably to new living environment with no changes in mood or behavior. Review of physician assistant (PA) progress notes dated 04/15/22 revealed Resident #117 had cerebral atherosclerosis with behaviors and was evaluated for delusions. Resident #117's daughter stated her mother had increased delusions, distressed, and tearful. Resident #117's daughter said many things her mother is saying are not based on reality, such as her spouse is cheating, etc. Resident #117 is currently on Seroquel 25 mg PO BID. Review of an facility internal email dated 04/14/22 from Licensed Social Worker (LSW) #9 to members of the Interdisciplinary Team (IDT) members revealed LSW #9 spoke with Resident #117's daughter who expressed concerns regarding her mother's demeanor, citing that Resident #117 had become increasingly delusional, distressed, and tearful. Resident #117's daughter reported Resident #117 says many things that are not based in reality (such as spouse is cheating on her) and wanted the physician to Page 1 of 2 365493 365493 10/27/2022 Bethany Village 6451 Far Hills Avenue Dayton, OH 45459

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few be consulted regarding whether or not an increase in Seroquel was warranted. Nursing staff was to make the physician aware of Resident #117's daughter's request and provide supporting documentation in the clinical record of Resident #117's mood for physician reference. Further review of Resident #117's medical record from admission from 03/09/22 (date of admission to dementia care unit) through 04/15/22 revealed no documentation of any increase in behaviors such as delusions, distress, or tearfulness. Interview with the Director of Nursing (DON) on 10/27/22 at 1:40 P.M. confirmed there was not documentation in the medical record of any increase of Resident #117's behaviors that would justify an increase in the antipsychotic Seroquel on 04/15/22. The DON confirmed nursing staff should monitor and document any increase in behaviors in a resident's medical record. Review of the facility's policy titled Use pf Psychotropic Drugs dated effective 04/16/91 and last revised 05/13/22 revealed the IDT will monitor to verify that residents who receive psychotropic drugs either are currently exhibiting identified symptoms, behaviors or have a history of said behaviors. Behaviors include but are not limited to the following: a. Sundowning; b. Severe anger; c. Aggression; d. Agitation related to sundowning; e. Agitation due to pain (i.e. osteoarthritis); and f. Anxiety. The IDT is responsible for the following: a. Reviewing the resident's behaviors as indicated; b. Monitoring to ensure behaviors are tracked; c. Providing direction to unit nurse regarding consulting with and discussing with the physician any recommended psychotropic drug changes; and d. The MDS nurse will verify that the AIMS (abnormal involuntary movement score) test is done initially and every six months thereafter for antipsychotic drugs. 365493 Page 2 of 2