Nearly all nursing home residents receive medicine to treat illness and maintain their health. Detailed federal and state rules instruct nursing homes and physicians on how to properly order, record, store, administer and monitor medications. Some other common medication issues include the following topics.
Consent: Residents and their legal representatives have the right to consent to or to refuse any treatment, including use of medications. Physicians must seek consent before ordering or changing medications.
Choice of Pharmacy: Residents have the right to choose their own pharmacy, subject to certain limitations.
Timely Availability: Nursing homes must have 24–hour arrangements with one or more pharmacies to ensure that residents receive ordered medications on a timely basis.
A drug, whether prescribed on a routine, emergency, or as needed basis, must be provided in a timely manner. This requirement is not met if the late administration of a prescribed drug causes the resident discomfort or endangers his or her health and safety. Doses shall be administered within one hour of the prescribed time unless otherwise indicated by the prescriber.
Unnecessary Drugs: Over–prescribing medications is a dangerous but common problem in nursing homes. Federal law addresses this problem by prohibiting nursing homes from using unnecessary drugs. An unnecessary drug is any drug given: (1) in excessive dose; (2) for an excessive period of time; (3) without adequate monitoring; (4) without adequate justification; or (5) in the presence of adverse consequences which indicate the dose should be reduced or discontinued.
Restricted Drugs: Federal regulations place special restrictions on the use of certain drugs. Sedatives, tranquilizers and similar drugs can only be used if the medical need is clearly documented. Federal guidelines discourage nursing homes from using a detailed list of drugs that have a high potential for severe adverse outcomes when used to treat older persons.
Residents cannot be given antipsychotic drugs unless they are necessary to treat a mental illness that has been diagnosed and documented in the resident’s clinical record. If antipsychotic drugs are used, the nursing home must try to discontinue them by using behavioral interventions and gradual dose reductions, unless clinically contraindicated.
Drug use to treat behavior symptoms is highly restricted. Except in an emergency, it is generally illegal to chemically restrain a resident, which means to control a resident’s behavior through drug use when other forms of care and treatment would be more appropriate. Nursing homes cannot sedate residents to cover–up behavioral symptoms caused by: (1) environmental conditions such as excessive heat, noise, and overcrowding; (2) psychosocial problems such as abuse, taunting, or ignoring a resident’s customary routine; or (3) treatable medical conditions such as heart disease or diabetes.
