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Study Finds Most Psychotropic Drug Use in Nursing Homes Meets Federal Guidelines

Donna Young

Psychotropic drug use in nursing homes is higher than in 1995 but is generally appropriate, according to a study released by the Department of Health and Human Services Office of Inspector General (OIG).

The Senate Special Committee on Aging asked OIG to examine the extent to which psychotropic drugs are being used as inappropriate chemical restraints in nursing homes.

Chemical restraints to control an individual’s behavior are legally appropriate only if used to ensure the physical safety of residents and other individuals, according to OIG.

The study found that 85% of nursing-home residents’ use of psychotropic drugs, defined as antipsychotics, antidepressants, antianxiety agents, and hypnotic drugs, was medically appropriate and within Medicare’s guidelines.

OIG reported that 8% of the residents whose records were examined had received psychotropic drugs in the following inappropriate ways: inappropriate dosage, unjustified chronic use, lack of documented benefit to the resident, wrong drug administered, and unnecessary duplication of drug therapy.

For the remaining 7% of residents, OIG could not determine the appropriateness of their psychotropic drug use due to insufficient documentation in the medical record.

According to the study, an increase in mental disorders among nursing-home residents might have contributed to the increase in psychotropic drug use. From 1995 to 1999, the percentage of residents with a documented psychiatric disorder, excluding dementia, increased from 13% to 16%. During the same period, the overall usage rate of antipsychotic drugs in nursing-home residents grew from 16% to 19.4%; antianxiety drug use increased from 14.3% to 15.7%.

In the report, OIG reviewers noted that at least one third of the nursing-home residents in the sample were already receiving a psychotropic medication when they entered the facility.

As a supplement to the study, OIG reviewers selected 10 nursing homes for site visits on the basis of their psychotropic drug-use rate, geographic variation, facility size, and ownership category. These nursing homes were located in California, Florida, Idaho, Maryland, Massachusetts, Missouri, New York, Ohio, Texas, and Wisconsin.

In each nursing home, the reviewers conducted interviews with administrative and directive staff members, toured the facility, and spoke with residents.

All 10 nursing homes in the follow-up study indicated that they evaluate residents before initiating psychotropic drug therapy and begin monitoring behavior at the time of admission for residents already taking psychotropic drugs.

According to the study, many of the nursing homes indicated that they consider drug-regimen review process conducted by a consulting pharmacist an "important element" for monitoring psychotropic drug use. In addition, many nursing homes claimed to use interdisciplinary committees for monitoring purposes.

Overall, the study found that respondents expressed a general reluctance to use a psychotropic drug solely as a chemical restraint. However, 8 of the 10 nursing homes explained that they might use the drugs when residents’ behavior is harmful to themselves or others. The other two nursing homes indicated that they have not had to use chemical restraints.