Over Medication in Nursing Homes

Study finds Link between Higher Registered Nurse Hours and Lower Antipsychotic Drug Use

The federal Nursing Home Reform Law requires every nursing facility to have a registered nurse on duty eight hours a day, seven days a week. Despite the existence of this minimal floor for registered nurse hours, some nursing homes still fail to meet this requirement. Data from the newly implemented payroll-based journal (PBJ) system shows that, for at least one day in the last quarter of 2017, 25 percent of facilities “reported no registered nurses at work.” As many reports have indicated, quality of care and quality of life among nursing home residents suffer when inadequate staffing exists. A recently published report in the Journal of Psychiatric and Mental Health Nursing (JPMHN) now lends further evidence that registered nurse hours and antipsychotic drug use are linked.  According to “An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses,” increasing registered nurse hours could reduce antipsychotic drug use among residents. The study found that just “[o]ne additional registered nurse hour per resident day could reduce the odds of antipsychotic use by 52% and 56% for residents with and without a dementia diagnosis respectively.” Looking at nursing homes in the state of Missouri, the study found that meeting the national average in registered nurse hours (.8) would reduce the odds of inappropriate antipsychotic drug use among residents with and without dementia by 22 percent and 25 percent, respectively.

The authors of the study concluded by stating that nursing homes “must work to reduce APM [antipsychotic medication] use, primarily for residents’ health, but also for certification and survey outcomes.” The authors also encourage the use of evidence-based nonpharmacological interventions to reduce the use of antipsychotic drugs and comply with federal regulations.

•For more information about the registered nurse hours of any given nursing home, please see LTCCC’s nursing home staffing data for the first quarter of 2018, available at  https://nursinghome411.org/nursing-home-staffing-2018-q1/.

•To learn about resident rights in relation to antipsychotics, please see LTCCC’s Issue Alert on antipsychotic drugs, available at https://nursinghome411.org/issue-alert-antipsychotic-drugs/.

•To learn about the federal nursing home staffing requirements, please see LTCCC’s Issue Alert on staffing, available at https://nursinghome411.org/ltccc-issue-alert-nursing-home-staffing-requirements/.https://onlinelibrary.wiley.com/doi/abs/10.1111/jpm.12488

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