Have you ever read a report that makes you stop and think? Two recently released reports from the Office of Inspector General (OIG) raise concerns about antipsychotic medications and the way some communities manage prescribing practices and resident diagnoses. Consequently, the findings serve as an important reminder for senior living communities to regularly review medication use, documentation, and behavioral health interventions.
The first report focused on antipsychotic medications among residents living with dementia. Importantly, these medications do not have FDA approval to treat dementia. Furthermore, the FDA warns that they may increase the risk of death in older adults with dementia. Investigators found cases where staff lacked adequate documentation. In addition, caregivers did not consistently monitor residents for side effects. Likewise, communities missed opportunities to attempt gradual dose reductions. Additionally, staff did not always try non-pharmacological interventions before turning to medication. The Office of Inspector General’s report, Nursing Homes’ Inappropriate Use of Antipsychotic Drugs Poses a Risk to Residents, provides additional details about these findings and recommendations.
The second report examined schizophrenia diagnoses. For example, investigators found situations where providers assigned schizophrenia diagnoses after prescribing antipsychotic medications. According to the OIG, some communities may have used those diagnoses to exclude residents from publicly reported quality measures. As a result, reported antipsychotic medication rates may not have reflected actual use. Furthermore, inaccurate diagnoses can affect care planning and resident outcomes. Moreover, the OIG noted that these practices may weaken important resident protections. The companion report, Nursing Homes Inappropriately Diagnosed Residents With Schizophrenia To Mask the Misuse of Antipsychotic Drugs, explores these concerns in greater detail.
While the reports reviewed a limited number of inspections, the message is clear. Therefore, communities should regularly review antipsychotic medication use. Accurate diagnoses matter. Documentation matters. Ongoing monitoring matters. Moreover, residents benefit when caregivers consider non-pharmacological approaches first. In addition, pharmacists, medical providers, and nursing staff all play important roles. Together, they help ensure medications remain appropriate and necessary.
These reports raise important questions about antipsychotic medication oversight and provide an excellent opportunity for review. Therefore, bring this information to your next QAPI, Pharmacy, or Behavioral Health meeting. Review current antipsychotic medication use. Next, confirm diagnoses are accurate and properly documented. Then, evaluate non-pharmacological interventions. Finally, verify that staff meet monitoring requirements. Overall, these reports serve as a valuable reminder that careful medication management supports quality resident care.
Stay well and stay informed!
