An indicator of appropriate neuroleptic prescribing in nursing homes.

OBJECTIVE To derive and apply objective criteria which assess the appropriateness of neuroleptic prescribing, in a random sample of nursing homes. DESIGN Cross-sectional survey of prescribing in a random sample of nursing homes. SETTING 22 homes with more than 35 residents in the former South Thames Region. SUBJECTS 934 nursing home residents aged 65 years or over. METHODS We compared criteria of appropriate neuroleptic prescribing, including appropriate indication and review, to clinical data documented in the nursing and GP notes of residents prescribed neuroleptics. RESULTS Of the 229 (24.5%) residents prescribed neuroleptics, clinical notes were available for 225. Clinical data indicated that only 40/225 (17.8%) residents receiving neuroleptics received appropriate therapy. The intra-cluster correlations for appropriate and inappropriate prescribing of neuroleptics were 0.038 and 0.12 respectively. It was not possible to derive reference ranges of observed prescribing that included homes demonstrating appropriate prescribing whilst excluding those with inappropriate prescribing. Thus, clinical data are needed whenever neuroleptic appropriateness is assessed. Criteria were readily applicable in nursing homes. CONCLUSION Application of criteria of appropriate neuroleptic prescribing in a random sample of nursing homes identified suboptimal prescribing to elderly residents.

[1]  L. Grant,et al.  Psychotropic drug use in long-term care facilities: a review of the literature. , 1992, The Gerontologist.

[2]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[3]  A. Wilson.  The British National Formulary. , 1963, The Practitioner.

[4]  L. Schneider,et al.  A Metaanalysis of Controlled Trials of Neuroleptic Treatment in Dementia , 1990, Journal of the American Geriatrics Society.

[5]  B. Svarstad,et al.  The Impact of Regular Multidisciplinary Team Interventions on Psychotropic Prescribing in Swedish Nursing Homes , 1998, Journal of the American Geriatrics Society.

[6]  S. Baker,et al.  Medications and Diagnoses in Relation to Falls in a Long‐Term Care Facility , 1987, Journal of the American Geriatrics Society.

[7]  M. Lichtenstein,et al.  Thioridazine Dose‐Related Effects on Biomechanical Force Platform Measures of Sway in Young and Old Men , 1998, Journal of the American Geriatrics Society.

[8]  A. B. Prasad,et al.  British National Formulary , 1994 .

[9]  L. Melton,et al.  Psychotropic drug use and the risk of hip fracture. , 1987, The New England journal of medicine.

[10]  D. Brauner,et al.  Effect of the Omnibus Reconciliation Act 1987 on Antipsychotic Prescribing in Nursing Home Residents , 1994, Journal of the American Geriatrics Society.

[11]  L. Schneider,et al.  Optimal Management of Behavioural Disorders Associated with Dementia , 1997, Drugs & aging.

[12]  M J Lichtenstein,et al.  Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. , 1993, Archives of internal medicine.

[13]  S. Guthrie,et al.  Antipsychotic drug use in older adults. , 1994, American journal of hospital pharmacy.

[14]  W. Ray,et al.  Effects of Antipsychotic Withdrawal in Elderly Nursing Home Residents , 1994, Journal of the American Geriatrics Society.

[15]  J. Wegiel,et al.  Neurofibrillary Pathology in Brains of Elderly Schizophrenics Treated With Neuroleptics , 1994, Alzheimer disease and associated disorders.

[16]  G. Jackson,et al.  Survey of neuroleptic prescribing in residents of nursing homes in Glasgow , 1996, BMJ.

[17]  S R Salem-Schatz,et al.  A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. , 1992, The New England journal of medicine.

[18]  C. Fairburn,et al.  Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up , 1997, BMJ.

[19]  C. Swift,et al.  Development of prescribing indicators for elderly medical inpatients. , 1997, British journal of clinical pharmacology.

[20]  T. Walley,et al.  A study of the appropriateness of prescribing in nursing homes , 1997 .