Unnecessary Drugs Given to Residents
It is common for nursing homes and other to give residents unnecessary drugs medications, including antipsychotic drugs and psychotropic medications, this is often done for the convenience of the staff and caregivers, rather than for the benefit of the resident. It is my experience that heavily medicated residents are less active and require less supervision and interaction.
Federal Regulations establish guidelines on medication errors and measures which must be followed to reduce the likelihood of errors – 42 CFR 483. Nursing Home Regulations
(l) Unnecessary drugs —(1) General. Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:
(i) In excessive dose (including duplicate drug therapy); or
(ii) For excessive duration; or
(iii) Without adequate monitoring; or
(iv) Without adequate indications for its use; or
(v) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
(vi) Any combinations of the reasons above.
(2) Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that—
(i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and
(ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.
According to a New England Journal of Medicine, 2005, article, Risk of Death in Elderly Users of Conventional vs. Atypical Antipsychotic Medications: Conventional antipsychotic medications were associated with a significantly higher adjusted risk of death than were atypical antipsychotic medications at all intervals studied (≤180 days: relative risk, 1.37; 95 percent confidence interval, 1.27 to 1.49; <40 days: relative risk, 1.56; 95 percent confidence interval, 1.37 to 1.78; 40 to 79 days: relative risk, 1.37; 95 percent confidence interval, 1.19 to 1.59; and 80 to 180 days: relative risk, 1.27; 95 percent confidence interval, 1.14 to 1.41) and in all subgroups defined according to the presence or absence of dementia or nursing home residency. The greatest increases in risk occurred soon after therapy was initiated and with higher dosages of conventional antipsychotic medications. Increased risks associated with conventional as compared with atypical antipsychotic medications persisted in confirmatory analyses performed with the use of propensity-score adjustment and instrumental-variable estimation.
Improving Dementia Care and Reducing Unnecessary Antipsychotic Medications in Nursing Homes, an online training for nursing home staff.
If you or someone you love has been the victim of a medication overdose, given contraindicated or unnecessary drug or wrong medication, or some other form of medication error, contact an experienced nursing home abuse and neglect attorney for a free consultation. Attorney Kenneth L. LaBore can be reached by phone at 612-743-9048 or toll free at 1-888-452-6589, and by email at KLaBore@MNnursinghomeneglect.com.