Bushwick Center for Rehabilitation and Healthcare, a nursing home located in Brooklyn, NY, was cited by the Department of Health in a December, 2012 deficiency report for several violations of the Code of Federal Regulations. Among these failures was the facility’s duty to keep a resident’s drug regimen free from unnecessary drugs.
In relevant excerpts for the resident described in the DOH report, Title 42 section 483.25(l) states that an unnecessary drug is one that is used in excessive dosage, or an antipsychotic medication used without behavioral interventions in an effort to discontinue usage of such a drug. The resident in question was an eighty year old female with various underlying medical conditions, including mild dementia, depression, and altered mental status. Upon admission to Bushwick, the patient was placed on two medications: Haldol every six hours, and Seroquel.
The Department of Health took issue with each of these prescriptions, citing a different reason for each. When the patient was discharged from the hospital to Bushwick, the discharge order stated that she was to be given Haldol “as needed.” When admitted to Bushwick, the home placed the resident on a standing order of Haldol every six hours. In a subsequent interview, the resident’s physician stated that “he was told” that Haldol was to be administered every six hours. He was unaware of the contrary prescription from the hospital. The Medical Director confirmed that the prescription alteration at the home was human error.
With respect to Seroquel, the nursing home prescribed this to ease the resident’s insomnia. Upon inspection of her medical records, however, the Department of Health found no record of insomnia. In the same interview with the Medical Director referenced above, he expressed concern that the psychiatrist was unaware of the Haldol prescription when ordering the Seroquel. This concern contradicts a statement made by the attending physician, who believed that the psychiatrist did, in fact, conduct some sort of oversight regarding the patient’s medications. Based upon this assumption, the physician stated that because the psychiatrist made no changes to the resident’s prescriptions, he (the physician) felt “that it was okay.”
Communication between treating physicians in a nursing home is critical. A resident, particularly a resident suffering from dementia or other psychological impairments, cannot be responsible for monitoring his or her own medications. As such, this duty falls entirely upon the facility. Without proper monitoring of prescriptions mistakes such as the ones detailed above have a greater tendency to occur. The potential ramifications that may occur in the case of medication error are quite serious, though–possibly even deadly. The Medical Director assured the DOH that in the future the physician would take greater care to document appropriate diagnoses in an attempt to avoid situations such as this.
The Department of Health write-up of this and several other violations by Bushwick can be found here.