RSS Feeds
Polypharmacy in Skilled-Nursing Facilities
- Edward J. Slater, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Beers and colleagues [1] strike a resonant chord with geriatricians by quantifying previous concerns that inappropriate medication prescribing is common in nursing homes [2]. After observing polypharmacy in an 82-bed nursing home, we devised a strategy to improve management of drug use [3]. National standards were used for diabetic, hypertensive, and antipsychotic drug therapy. Because the medications were used to maintain function and comfort, outcome assessment was performed. Use of the computerized Patient Assessment Instrument demonstrated by Rudman and colleagues [4] to be effective in quality management in Veterans Affairs nursing homes. Portions of the Patient Assessment Instrument are identical to the Minimum Data Set mandated by OBRA-87 for use in most nursing homes.
National standards of care such as OBRA-87 guidelines [5], although requiring clinical judgment when applied to individual patients, were valuable in overcoming institutionalized resistance to change. Within 3 months, the average antipsychotic drug dose decreased 46%, and total medication prescriptions decreased from 7.1 to 5.8 drugs per resident. Nursing morale and efficiency improved after the decrease from 8.4 to 6.4 doses per resident. Elimination of excessive drug prescribing in a short time reinforced acceptance of change.
Now that the scope of the problem is defined, clinicians must become actively involved in devising and studying interventions to improve prescribing in nursing homes.
Edward J. Slater
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
