Overwhelming misuse, faulty documentation of antipsychotic drugs in nursing homes, OIG report states

A stunning 99 percent of nursing home records examined by the Office of Inspector General (OIG) failed to meet at least one of the federally required assessment or documentation steps for administering antipsychotic drugs under Medicare/Medicaid, according to an OIG report released this week.

One-third of the examined records showed no evidence that residents receiving antipsychotic drugs were ever assessed for the medical need of the drugs. Eighteen percent of the records indicated no intervention plan for antipsychotic drug use, and four percent showed no use of the Resident Assessment Protocol for psychotropic drugs. All but one of the records failed to provide documentation to prove that a care plan was in place.

In response to the disturbing findings, the OIG has urged the Centers for Medicare & Medicaid Services to step up its monitoring of antipsychotic drug use and to take strong action against nursing homes that are not in compliance with the regulations. The OIG report further supports the CMS efforts already underway to reduce the unnecessary use of antipsychotic drugs in nursing homes, especially in relation to residents with dementia.

To receive reimbursement under Medicare/Medicaid for antipsychotic drug administration, nursing homes must document four specific steps: (1) Resident assessment, (2) consideration of the Resident Assessment Protocol for psychotropic drug use, (3) development of a care plan, and (4) planned interventions for antipsychotic drug use.

The report reviewed a random sampling of care records for residents who had Medicare claims for atypical antipsychotic drugs during a six-month period in 2007.