More Drug Rules Needed in Nursing Homes

This section is compiled by Frank M. Painter, D.C.
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By Peter Eisler

USA Today
Mon., Nov. 17, 1997
FINAL EDITION
Section: NEWS
Page 3A

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WASHINGTON -- Ten years after Congress attacked improper drug use by nursing homes in a sweeping set of reforms, federal investigators say tougher rules are needed to combat lingering problems.

In a report today that suggests thousands of nursing home patients get "inappropriate" medicine, the Department of Health and Human Services inspector general sees Congress' 1987 reforms as largely successful. No longer are patients commonly drugged into submission.

The big problem now tends to be unwitting errors, the report says, resulting in poor drug interactions, overmedication and bad reactions.

"Our recommendations will require doctors, nurses and pharmacists to work together more effectively," says George Grob, a deputy inspector general who worked on the report. "The systems that were put in place 10 years ago clearly are beginning to work, but more needs to be done."

On Capitol Hill, some were more critical.

"Neither the spirit nor the intent of the (1987 reforms) relating to prescription-drug use are being fulfilled," says Sen. Charles Grassley, R-Iowa, who chairs the Special Committee on Aging. "These concerns merit prompt and definitive action." Grassley wants a report next year on what has been done. The report recommends that nursing homes be required to:

Keep better records on what drugs patients are taking and what results are expected. Ensure pharmacists review drug use and see that their concerns reach doctors and nurses. Better train staff to recognize adverse drug reactions.

Industry groups concede some of the problems cited by the report but reject the call for new rules.

"Some of the (studies') findings . . . could be helpful," the American Association of Homes and Services for the Aging (AAHSA) says in a letter to the inspector general. "However, we are concerned with some of the methodologies used in the study, the limited nature of the findings and the recommendations for new program requirements that are not justified."

AAHSA and other industry groups note that the studies' assumptions of inappropriate drug use are based largely on a national survey of nursing home pharmacists, whose reporting may be biased by a desire for more authority.

They also dispute the importance of findings from an audit of 254 patients in Texas that up to 17% of nursing home patients there get improper drugs. What happens in Texas isn't necessarily what happens nationwide, they say.

"What this (report) does is peel off another layer," says Sarah Burger of the National Citizens Coalition for Nursing Home Reform. "People aren't taking 15 or 20 different drugs anymore, so there's progress. But even with fewer drugs, the ones they are taking aren't being monitored in a way that prevents untoward outcomes."

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