LETTER
Polypharmacy in Skilled-Nursing Facilities
Edward J. Slater
15 April 1993 | Volume 118 Issue 8 | Pages 649-651
TO THE EDITOR:
Beers and colleagues [1] strike a resonant chord with geriatricians by quantifying previous concerns that inappropriate medication prescribing is common in nursing homes [2]. After observing polypharmacy in an 82-bed nursing home, we devised a strategy to improve management of drug use [3]. National standards were used for diabetic, hypertensive, and antipsychotic drug therapy. Because the medications were used to maintain function and comfort, outcome assessment was performed. Use of the computerized Patient Assessment Instrument demonstrated by Rudman and colleagues [4] to be effective in quality management in Veterans Affairs nursing homes. Portions of the Patient Assessment Instrument are identical to the Minimum Data Set mandated by OBRA-87 for use in most nursing homes.
National standards of care such as OBRA-87 guidelines [5], although requiring clinical judgment when applied to individual patients, were valuable in overcoming institutionalized resistance to change. Within 3 months, the average antipsychotic drug dose decreased 46%, and total medication prescriptions decreased from 7.1 to 5.8 drugs per resident. Nursing morale and efficiency improved after the decrease from 8.4 to 6.4 doses per resident. Elimination of excessive drug prescribing in a short time reinforced acceptance of change.
Now that the scope of the problem is defined, clinicians must become actively involved in devising and studying interventions to improve prescribing in nursing homes.
1. Beers MH, Ouslander JG, Fingold SF, Morgenstern H, Reuben DB, Rogers W, et al. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med. 1992; 117:684-9.
2. Institute of Medicine. Improving the Quality of Care in Nursing Homes. Washington, DC: National Academy Press; 1986.
3. Slater EJ. Strategic management of drug use in a nursing home (Abstract). J Am Geriatr Soc. 1992; 40(Suppl):SA63.
4. Rudman D, Abbasi AA, Tourky GM, Rudman IW, Mattson DE. Easily measurable adverse outcome indicators in a Veterans Affairs nursing home. QRB. 1990; 16:257-63.
5. Ouslander JG, Osterweil D, Kane RL. Medical Care in the Nursing Home. New York: McGraw-Hill; 1991.
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