Magazine article Drug Topics

The Hidden Problem

Magazine article Drug Topics

The Hidden Problem

Article excerpt

Rx use and review in nursing homes need improvement, OIG report finds

Nursing home patients are experiencing numerous adverse reactions because of inappropriate prescribing and inadequate monitoring of medications, according to a survey of consultant pharmacists. Conducted by the Office of Inspector General of the Department of Health & Human Services, the survey found serious concerns about the prescribing of antipsychotics, anxiolytics, sedatives/hypnotics, and antidepressants. The consultants believe that the drugs being prescribed in the nursing homes where they conduct monthly reviews contribute to patients' urinary incontinence, reported by 26% of the R.Ph.s; depression, 39%; delirium, 41%; falls, 66%; and constipation, 81 %.

The R.Ph.s listed the monitoring problems that sometimes occur. Among them:

* No lab testing to ensure the drug is still needed, 61%

* Failure to chart drug usage, 59% Drug-drug interactions not detected, 57%

* No lab testing to monitor potentially toxic drugs, 51%

* Failure to adjust dosages for renal/ hepatic function, 50%

* No monitoring for efficacy or side effects, 50%

Four in 10 consultants judged the extent of cooperation they receive from a patient's physician as only fair or poor. They said that the M.D.s do not always give serious consideration to their views (28% of the R.Ph.s felt that way), and 35% said "doctors only rarely or sometimes take prompt action on their recommendations about a specific resident's prescriptions or medication regimen."

Two nursing home groups suggested to the OIG that it not publish the report on the survey, An Inside View by Consultant Pharmacists. "The data represent personal opinions of consultant pharmacists rather than accurate reports of activities within nursing facilities," said the American Association of Homes & Services for the Aging, which represents not-forprofit nursing homes. "It does not present a realistic picture on which to base policy considerations." Similarly, the American Medical Directors Association said, "The findings of this survey are interesting but may be more appropriate for a pharmacists' journal than a federal agency."

The survey report was among three the OIG issued last month based on inspections of prescription drug use in nursing homes. One analyzes Medicaid drug payments in Texas nursing homes, and the other discusses an independent review of drug and medical records from a sample of nursing homes conducted by pharmacists under contract to the OIG. …

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