Audit of Psychotropic Use in Nursing Homes Acts as Additional Patient Safety Support

Polypharmacy, the simultaneous use of multiple medications at once, is a reality of our era. Statistics indicate that more than 40% of older adults take at least five prescription medications, while the average person is said to take four prescription medications. 

Dangers arise, however, when medications are inappropriately prescribed, dispensed or ingested.

And regulatory bodies are not only taking notice, but they are taking action to try and protect one of the nation’s most vulnerable populations — the elderly, particularly those living in long-term care facilities. 

The Centers for Medicare and Medicaid Services (CMS) announced in January that it would begin conducting targeted audits of nursing homes as part of a Biden administration crackdown aimed at reducing the inappropriate use of antipsychotic medications. 

The audits come after a government watchdog report found that about 80% of Medicare’s long-term care nursing home residents were prescribed an antipsychotic between 2011 and 2019, raising an alarm about potential misuse of schizophrenia diagnoses and the medications used to treat it, according to a report in The Hill

In essence, the CMS audits aim to reconcile whether the patients receiving the antipsychotic medications were diagnosed properly, as consumer advocates have long asked for this specific type of oversight. 

As pharmacists supporting long-term care facilities, such as nursing homes and assisted living communities, we at UnitedRx are acutely aware of the regulatory environment, its stipulations as it relates to polypharmacy and the problems that can arise from it. It’s why we adhere to a strict internal protocol that helps us help our partners as we collectively navigate environments where the average patient is using 11 medications, compared to the national average of 14 for nursing home residents.

In fact, we have staff members dedicated to analyzing this very issue on a monthly, and even daily, basis. As pharmacists, we’re mandated to. And, we’re required to monitor psychotropic medications, specifically, for gradual reductions. 

If and when we determine that a physician or facility may be in danger of running afoul of compliance with regulations, which could impact patient safety and result in a costly F-tag from regulators, we alert them to that possibility and advise them of our recommendations. 

We recognize that we are not the only backstops for physicians and facilities working with patients in need of multiple medications, but as long-term care pharmacists we understand our responsibility to the providers with whom we work and the patients they treat. 

However, in addition to our recommendations, providers need to offer detailed diagnostic criteria to justify certain prescriptions and, when working with insurance, they sometimes need preauthorization for certain medications.

In addition, if a prescription goes outside the normal dosing limits, it can be filled but won’t be billed. 

Even despite an established system of checks and balances, and the threat of regulatory penalties, long-term care facilities may still inappropriately diagnose patients or inappropriately dispense medication, as the watchdog report suggests. 

As a long-term care pharmacy, we at UnitedRX remain vigilant in reviewing prescriptions and dispensing information, and work with our long-term care partners to prioritize patient safety and keep providers in compliance with regulations. 

At UnitedRX, we deliver a hometown pharmacy experience to more than 350 clients across the country. Contact us to learn more about how our approach to treatment can meet the pharmacy needs of your long-term care facility.