USE OF ANTIPSYCHOTIC-DRUGS IN NURSING-HOMES - CURRENT COMPLIANCE WITHOBRA REGULATIONS

OBJECTIVE: To examine tile degree and patterns of compliance with the Omnibus Budget Reconciliation Act (OBRA) regulations regarding the use of antipsychotic drugs in nursing homes. DESIGN: Retrospect-ive chart review oi all resident records. PARTICIPANTS: Eight nursing homes: fi ve community, two county-owned, and one university-affiliated Veterans Administration facility. MEASUREMENTS: A structured assessment instru ment to track compliance with each aspect of the OBRA regulations rega rding antipsychotic drug use. RESULTS: A total ol 1573 nursing home re sidents' pharmacy records were reviewed between August 1994 and March 1996, Two hundred seventy-nine residents were actively taking antipsyc hotic medications (prevalence = 17.7%), Mean compliance greater than 7 0% was found for (I) appropriate diagnostic indication ((X) over bar = 70.9%), (2) dosage within recommended limits ((X) over bar = 90.1%), and 3) documented appropriate target symptoms ((X) over bar = 90.4%), Dosages were more likely to exceed limits in those patients with histo ries of major mental illness, particularly schizophrenia. CONCLUSION: Nursing homes were better able to comply with those guidelines that ar e most specific. Educational interventions now need to locus on behavi oral interventions, monitoring of adverse effects, and efficacy. These data are useful in establishing threshold levels of performance and c an be used by nursing homes for continuous quality improvement. OBRA c ontinues to impact neuroleptic drug prescribing practices in nursing h omes significantly.