Although recent studies have shown that antipsychotic medications should be used with great caution, I'm unhappy that Weiser wonders whether we're "chemically restraining our nursing home residents for our own convenience" because we don't have enough well-trained staff. The 1987 Omnibus Budget Reconciliation Act, which set minimum standards for nursing homes, clearly outlines the appropriate use of psychotropic drugs in long-term care residents. We are not to use any medication, including an antipsychotic, to restrain patients.
In California we have many regulations that guide the safe use of antipsychotics. Prescribing them requires an appropriate diagnosis and frequent monitoring. Consent must be obtained from the party (family member, health care proxy) responsible for the patient's care before they are used. I clearly outline the risks and the black box warnings on these medications when I discuss their use. Our nurses are required to monitor patients weekly to see whether the medications help reduce the problematic behavior. The patient's health care provider must be informed if the medication doesn't help. The dose must be tapered at least every six months to determine whether the antipsychotic is still necessary.
It's true that long-term care isn't generally well funded and that most of the care is provided by nursing assistants, who are often poorly trained. However, the assistants aren't prescribing these medications. And LPNs and RNs are responsible for monitoring the patient for adverse effects and ensuring that falls are prevented, especially when these medications are newly prescribed.
The examples of poor care in the nursing home visited by Weiser aren't necessarily the result of overmedicating residents. Working in nursing homes with elderly patients who have dementia is very challenging. In my facility, the staff have done wonderful, creative things to help reduce the problem behaviors displayed by our residents. But no matter how well trained the staff-or how many interventions are tried in an effort to lessen the occurrence of problem behaviors-some residents really do need these medications.
Jennifer Serafin, GNP, RN
San Francisco