The prevalence of psychotropic drugs in nursing homes has increased in recent years in part due to the worsening of emotional and behavioral disorders exacerbated by the restrictive measures of the COVID-19 pandemic.[1] Consequently, F758 Psychotropic Drugs is one of the top 10 areas cited for deficient practice in the nation.

F758 Psychotropic Drugs [2] regulation states that –

  • 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;
  • Residents who use psychotropic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs;
  • 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
  • PRN orders for psychotropic drugs are limited to 14 days. Excluding anti-psychotic drugs, 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.
  • PRN orders for antipsychotic 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.


What is a psychotropic drug?

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:

      • Antipsychotic;
      • Antidepressant;
      • Antianxiety; and
      • Hypnotic.

How do we determine if psychotropic medication is necessary?

The medication must be necessary to treat a specific condition as diagnosed and documented in the clinical record. Proper medication selection and prescribing (including dose, duration, and type of medication(s)) may help stabilize or improve a resident’s outcome, quality of life, and functional capacity. Reducing the need for and maximizing the effectiveness of medications are important considerations for all residents. As part of psychotropic medication management, the IDT needs to implement non-pharmacological approaches designed to meet the individual needs of each resident. The indications for initiating, withdrawing, or withholding medication(s), as well as the use of non-pharmacological approaches, are determined by assessing the resident’s underlying condition, current signs, symptoms, and expressions, and preferences and goals for treatment.

How do we manage psychotropic medications for our residents?

The regulations associated with medication management include these considerations:

      • Indication and clinical need for medication;
      • Dose (including duplicate therapy;
      • Duration;
      • Adequate monitoring for efficacy and adverse consequences; and
      • Preventing, identifying, and responding to adverse consequences

Concerning psychotropic medications, the regulations additionally require:

      • Giving psychotropic medications only when necessary to treat a specific diagnosed and documented condition;
      • Implementing GDR and other non-pharmacologic interventions for residents who receive psychotropic medications, unless contraindicated; and
      • Limiting the timeframe for PRN psychotropic medications, which are not antipsychotic medications, to 14 days, unless a longer timeframe is deemed appropriate by the attending physician or the prescribing practitioner,
      • Limiting PRN psychotropic medications, which are antipsychotic medications, to 14 days and not entering a new order without the physician first evaluating the resident.

How do we monitor our facility practices?

Use the Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review Critical Element Pathway for a resident who is prescribed psychotropic medications to determine whether facility practices are in place to identify, evaluate, and intervene for potential or actual unnecessary medications. If a resident has a diagnosis of dementia and is receiving any psychotropic medications, refer also to the Dementia Care Critical Element Pathway.

Join Proactive on November 1, 2022 – Analysis of top 10 citations in the nation: F758 Free From Unnecessary Psychotropic Meds/PRN Use for a deep dive review of Survey Procedures related to this topic, as well as examples of IJ citations and recommended action steps to avoid the same or similar issues in your facility. Learn more and register at: Survey Success! Avoiding Top Citations – Proactive Medical Review

[1] Psychotropic Drug Prescription in Nursing Homes During the COVID-19 Pandemic. Ferro Uriguen et al.

[2] State Operations Manual Appendix PP – Guidance to Surveyors for Long Term Care Facilities




Eleisha Wilkes, RN, GERO-BC, RAC-CT, DNS-CT
Clinical Consultant

Learn more about the rest of the Proactive team.