Use of antipsychotic drugs in nursing homes: Current compliance with OBRA regulations

OBJECTIVE: To examine the 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 of all resident records. PARTICIPANTS: Eight nursing homes: five community, two county-owned, and one university-affiliated Veterans Administration facility. MEASUREMENTS: A structured assessment instrument to track compliance with each aspect of the OBRA regulations regarding antipsychotic drug use. RESULTS: A total ol 1573 nursing home residents' pharmacy records were reviewed between August 1994 and March 1996, Two hundred seventy-nine residents were actively taking antipsychotic medications (prevalence = 17.7%), Mean compliance greater than 70% 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 histories of major mental illness, particularly schizophrenia. CONCLUSION: Nursing homes were better able to comply with those guidelines that are most specific. Educational interventions now need to locus on behavioral interventions, monitoring of adverse effects, and efficacy. These data are useful in establishing threshold levels of performance and can be used by nursing homes for continuous quality improvement. OBRA continues to impact neuroleptic drug prescribing practices in nursing homes significantly.