California Pharmacists who are responsible for reviewing whether medications prescribed to nursing home residents are appropriate failed to identify the misuse of antipsychotic medications in 90% of the cases. Worth repeating: 90% of the cases. The New York Times recently published an article which discusses various findings of the California Department of Public Health relating to inappropriate use of dangerous drugs in nursing homes.
Pharmacy reviews are supposed to add an extra layer of safety for the nursing home resident. The goal was to mandate that a pharmacist routinely look at the medication regimens of nursing home patients to identify potential contraindications, unsafe doses, and use of medications which may not be appropriate for the elderly. But in 18 of 32 Bay Area investigations conducted in California between May 2010 and June 2011, consultant pharmacists overlooked or approved these very dangers.
I have written frequently about the dangers of anti-psychotic medications, which are not approved for use in elderly, demented patients and which increase the risk of death in this population. Still, the use of antipsychotics in nursing homes is wide-spread, and it is not uncommon for these drugs to be prescribed to control unwanted behavior, just as yelling, repetitive requests for help, efforts to get out of bed or wandering the halls, or agitation or resistance to efforts to provide care.
It is clear, based on these statistics, that the protective function of the consultant pharmacist is not effective in California. Still, the Department of Public Health did not issue citations or fines for these violations. Instead, the nursing homes received a "statement of deficiency" and were asked to submit a plan of correction. This is the equivalent of a slap of the wrist or a "fix-it" ticket, without any meaningful oversight to make sure the problems is, indeed, fixed. Unfortunately, unless there is greater accountability by the nursing homes, doctors, and pharmacists prescribing and reviewing these drugs, the misuse of these drugs is likely to continue.