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Michael A. Stratton
Michael A. Stratton
Attorney • 866-351-9500

Nursing Homes: Stopping Over Medication and Errors

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Proper medication management is integral to the care of nursing home residents. The average resident’s medication regime includes seven to eight different medications monthly, and a complex medication regime requires diligent attention by competent care providers.

The standard for nursing home medication safety is high. Federal regulations mandate that a “facility must ensure that residents are free from any significant medication errors,” and compliance with those regulations is part of the standard of care. This means nursing homes are required to design a system that is free from significant medication errors, thus ensuring that residents receive their medications in accordance with physicians’ orders.

The regulations also mandate that “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.” For residents who do require antipsychotic drugs, the facility must ensure that the resident “receive[s] gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.’

On May 20, 2012, the Centers for Medicare and Medicaid Services (CMS) announced “an initiative to ensure appropriate care and use of antipsychotic medications for nursing home patients” with a “national goal of reducing use of antipsychotic drugs in nursing home residents by 15 percent by end of 2012.” CMS reports that in “2010 more than 17 percent of nursing home patients had daily doses [of antipsychotic medications] exceeding recommended levels.” Furthermore, CMS found that “almost 40 percent of nursing home patients with signs of dementia were receiving antipsychotic drugs as some point in 2010, even though there was no diagnosis of psychosis.”

To ensure that residents receive their medications safely and in accordance with physician orders, professional standards of care require a licensed pharmacist to review each resident’s drug regime regularly. This review must occur at least monthly, and any irregularities need to be reported to the attending physician and the nursing home’s director of nursing, who have a duty to act on these reports. A nursing home’s drug regimen review is integral to maintaining a resident’s highest practicable level of functioning by preventing or minimizing adverse consequences related to medication therapy.

Further, nursing homes must provide laboratory services to meet their residents’ needs. Laboratory studies ordered by the physician or pharmacist are essential to evaluating the patient’s response to the medication. The nursing home is responsible for the quality and timeliness of such services, even if the facility does not provide laboratory services on-site.

The key here is real patient care. Simply over medicating the resident of a nursing home without a plan of monitoring is unacceptable.