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The “Other” 99% – OIG finds nursing home records lacking for patients on antipsychotic medications

This week, the OIG published its report on antipsychotic drug use in nursing facilities, which coincides with CMS’s recent announcement that it was putting together an initiative to reduce antipsychotic use by 15% by the end of 2013. The report, “Nursing Facility Assessments and Care Plans for Residents Receiving Atypical Antipsychotic Drugs,” utilizes information from a 2007 sampling of records of residents receiving atypical antipsychotic drugs.

The startling finding – 99% of records reviewed failed to meet one or more of the Federal requirements for resident assessments and/or care plans. The areas that had the most issues were lack of documentation for care planning and resident assessments, two areas that you can train your staff to improve on immediately.

Because nursing home residents that are receiving atypical antipsychotic drugs are at an elevated level of vulnerability, OIG and CMS are working towards implementing changes to reduce the use of these drugs. Based on the OIG report, here are some key reminders to help you avoid potential deficiencies in this area:

  1. Make sure your staff always signs off on MDS assessments. The OIG noted that if there was no signature on an assessment section or if there was no document at all, that it was considered non-compliant.
  2. Ensure your staff completes care plans within required time frames. Federal regulations require that care plans are completed with 7 days of a comprehensive analysis, and also must be developed by an interdisciplinary team. The resident’s family or representative should also be present during care planning, although specific guidelines have not been put out as to how much involvement is required.
  3. Your interdisciplinary team needs to be just that – comprised of multiple qualified health professionals. The OIG found that nearly 50% of the time, an RN was the only one responsible for the resident assessment. Best practices indicate that if antipsychotic medicines are being prescribed, that a qualified mental health professional should be involved.
  4. Regarding resident assessments, nearly 30% of the sample lacked quarterly assessments. Implement processes to ensure improvement occurs in this area.
  5. Review information across various forms of documentation to ensure consistency. The information that is contained in nursing records and assessment tools should provide support to MDS data. This information should be part of your QAPI program and is a good area of focus for a performance improvement project.
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