The OIG has also identified as a specific risk area for nursing facilities the inappropriate use of psychotropic medications. According to OIG, this issue comes up on two ways: 1) the inappropriate use of psychotropic medications as a chemical restraint; and 2) the use of unnecessary drugs.
Under the Federal OBRA statute and the corresponding regulations issued by CMS located at 42 CFR §§ 483.25(l) (unnecessary drugs) and 483.60 (pharmacy services), SNFs:
- Must ensure that psychopharmacological practices are consistent with Federal regulations and the applicable standard of care;
- Are responsible for the quality of drug therapy provided in the facility, even where they use outside pharmacies or pharmacy consultants;
- May not use any drug as a chemical restraint for purposes of convenience or discipline and which is not required to treat a resident’s medical symptoms;
- Ensure each resident’s drug regimen is free of unnecessary drugs;
- Ensure that for residents taking psychotropic medications, those residents receive gradual dose reductions and behavioral interventions aimed at reducing medication use, unless medically contraindicated.
As part of an effective compliance program, SNFs should ensure there is an actual, documented medical reason for the use of all medications, particularly psychotropic medications and that there is an active and regular review of each resident’s drug regimen. This process should involve the resident’s physician(s), and the facility’s medical director, consulting pharmacist and other care providers. The compliance program should include education for all those attending the resident about the SNF’s obligations, summarized above.
In addition, the facility should employ a system of auditing each resident’s care plan and drug regimen to ensure they are consistent and appropriate, and properly documented as to medication issues. The CMS Interpretive Guidelines for Surveyors, located at Appendix PP, pages 311-439, of the CMS Surveyor Manual, provide additional specifics regarding the issues CMS surveyors will examine on the issue of medication administration in general and the use of psychotropic medications specifically. This information should be a routine part of training for staff involved in the direct care of residents and the administration or monitoring of psychotropic drug use, as well as the facility’s consulting pharmacist and medical director.
Auditing and Monitoring for Appropriate Use of Psychotropic Medications
The following auditing and monitoring sample suggests one way facilities may approach the task of monitoring their use of psychotropic medications and ensuring compliance with the Federal requirement.