Dove Press had clinical guidelines on prescribing psychotropic medication for nursing home residents with dementia on their website.
Objective: The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs) to nursing home residents with dementia.
Subjects and methods: GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from south-eastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs’ opinions.
Results: A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141), and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126).
Conclusion: According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities.
The Santa Fe New Mexican reported that Casa Real nursing home in Santa Fe owned and operated by Preferred Care Partners Management Group has at least temporarily improved persistent quality-of-care problems enough to resume billing Medicare and Medicaid for newly admitted residents. Casa Real is one of only two homes in Santa Fe that accept Medicare and Medicaid patients.
For more than two months, Casa Real had been barred from charging Medicare or Medicaid for new residents after the Centers for Medicare and Medicaid Services found the nursing home wasn’t in compliance with federal care standards.
Inspections this year turned up a long list of problems, including medication errors, expired food and drugs on shelves, unreported resident injuries and assault, poor care of bed sores, nursing understaffing and inadequate safeguards against the spread of dangerous infections.
The former director of nursing at Casa Real from May to August has accused management of forging patient records in an attempt to show the facility was in compliance with care standards dealing with monitoring of medication effects on residents. Of course, she was soon fired.
The August inspection found residents weren’t receiving medications as directed by their physicians and that the nursing home wasn’t doing enough to ensure that residents didn’t receive unnecessary drugs, including psychotropic medications.
The federal agency in May designated Casa Real as a “special focus facility” because of its poor record of complying with care standards, and it said the nursing home would be subject to more frequent inspections. The designation is given to the nation’s poorest-performing nursing homes and is meant to address the “yo-yo” problem of facilities routinely falling in and out of compliance with care standards.
The state Attorney General’s Office is suing Preferred Care, alleging it has defrauded Medicaid by having insufficient staff to meet the needs of residents at its Santa Fe nursing homes, as well as its facilities in five other New Mexico communities. Preferred Care has denied the allegations.
St. Louis Today reported the tragic and preventable death of Robert L. Baehr. Baehr died in November 2015 of low blood sugar about two weeks after nurses at Bent-Wood Nursing and Rehab Center mistakenly gave him a prescription drug used to treat diabetes, which Baehr did not have. Baehr also received one dose of an antibiotic and four doses of a drug to lower blood pressure that he was not prescribed, the investigative report shows.
The drug was intended for another resident of the nursing home, and a nurse mixed up their records, according to an investigation by the U.S. Centers for Medicare and Medicaid Services. After Baehr’s death, the federal agency cited Bent-Wood for placing residents in immediate jeopardy, putting its funding at risk.
Baehr’s drug list got switched with another resident’s who was admitted the same day, according to investigators’ interviews with nursing staff. Investigators discovered that Baehr was given seven doses of glyburide, used to treat high blood sugar, one on Nov. 5 and two on each of the next three days. On Nov. 8, Baehr was found unresponsive and had a blood sugar level of 33 (normal levels are 70 to 100). He was revived with a sugar solution and orange juice. The next day he again became unresponsive with a blood sugar level of 33, and the sugar solution did not revive him. He never regained consciousness and died on Nov. 22. Federal records show the cause of death was profound hypoglycemia, or low blood sugar.
The Post and Courier reported the lawsuit filed by South Carolina against Purdue Pharma which is one of the largest pain pill manufacturers in the nation. The complaint filed is aimed at Connecticut-based Purdue Pharma, the maker of OxyContin — one of many synthetic opioids that have been manufactured, shipped, prescribed and sold throughout the United States.
The lawsuit accuses Purdue of failing to comply with a 2007 agreement it signed with South Carolina over allegations of its promotion of OxyContin. The State accuses the drug manufacturer of encouraging doctors to prescribe pain pills for unapproved uses and downplaying how addictive the company’s prescriptions are.
“Opioid addiction is a public health menace to South Carolina,” AG Wilson said as family members of overdose victims and addiction survivors stood behind him. “We cannot let history record that we stood by while this epidemic rages.” Wilson said the scourge has cost South Carolina billions of dollars.
More than 565 South Carolinians died of an overdose tied to highly addictive opioids in 2015, the most recent year that data is available. Opiods are the leading cause of death for Americans under the age of 50.
State Medicaid data shows that 1,855 prescriptions — or more than $1 million worth — of OxyContin reimbursed under the state-run insurance program last year. That number is down from the 3,620 prescriptions worth more than $2 million that were reimbursed in 2012.
Health in Aging reported on new research published in the June 2017 issue of the Journal of the American Geriatrics Society.
Medical experts know that older adults who have dementia or other mental health concerns that impact thinking or decision making should avoid certain “potentially inappropriate medications” (PIMs). PIMs can worsen confusion and raise the risks for falls, fractures, and even death, particularly for people with complex health needs.
PIMs may include treatments like:
- Benzodiazepines (medications sometimes called “tranquilizers” and used to treat sleep problems, anxiety, or to relax muscles)
- Antipsychotics (medications sometimes used to address mental health conditions)
- H2-blockers (medications sometimes used to decrease the production of stomach acid)
- Anticholinergics (medications that block a substance called acetylcholine, a “neurotransmitter” that transfers signals between certain cells to impact how your body functions. Anticholinergics have been used to treat several different conditions, including incontinence and chronic obstructive pulmonary disorder, or COPD).
Researchers investigated how often healthcare providers prescribed PIMs to older adults living with dementia or other mental health concerns in nursing homes. The research team discovered that 44 percent of people with dementia or cognitive impairment were taking a PIM. The frailer the person, the more likely they were to be taking a PIM.
After admission to a nursing home, many residents who were initially prescribed PIMs stopped taking PIMs:
- 5 percent stopped taking antipsychotic medications.
- 3 percent stopped taking benzodiazepines.
- 9 percent stopped taking H2-blockers.
- 2 percent stopped taking medications with anticholinergic properties that worsen memory or thinking.
A smaller percentage of study participants–from 1.2 percent to 10.9 percent, depending on the specific medication–were newly started on PIMs in the nursing home. Antipsychotics and benzodiazepines were the most frequently prescribed PIMs.
The researchers concluded that many nursing home residents with dementia or other cognitive impairments enter nursing homes on PIMs. They also concluded that PIMs are more likely to be prescribed for frail older adults after admission. The researchers suggested that strategies for a person-centered approach to discontinuing PIMs should be encouraged, especially for frail older adults.
It’s also important to remember that “potentially inappropriate medications” are just that: potentially inappropriate. They should be considered carefully before use, but that doesn’t mean that they should never be used in all cases or for all older people. If you have been prescribed a PIM or if you’re concerned about the way a treatment may affect your health, be sure to speak with your healthcare provider first before changing your routine or stopping the use of specific medications.
A former nurse, who previously pled guilty to tampering with a consumer product, was sentenced to imprisonment for a term of 48 months. Christina Lovern Calloway, while working as a nurse in a nursing home, diverted liquid morphine intended for patients to her own use. The defendant, on more than one occasion, took some of the liquid morphine from a bottle and used it herself. She then used tap water to refill the bottle in an attempt to hide her crime. The diluted morphine was then administered to patients.
KTLO reported that additional charges have been filed against a nurse who fled from law enforcement officers earlier this month following a traffic stop after police responded to a complaint of an intoxicated driver on July 16. When they located the vehicle and attempted to conduct a traffic stop, the driver refused to stop, and a short pursuit ensued.
The driver, Geneva Liveley, was apprehended and taken into custody. An inventory of the vehicle revealed numerous prescription medications belonging to other individuals, a loaded firearm, drug paraphernalia and cash totaling $1,110.
Liveley was charged with simultaneous possession of drugs and firearms, possession of a controlled substance (Hydrocodone), both felony counts, as well as misdemeanor charges.
Chief Manuel says an investigation began into Liveley’s possession of prescription medications belonging to other individuals. It was learned she worked at a local nursing home and stole medications from residents. The medications in her possession were logged by her as being received by the residents.
Liveley was arrested again and charged with four felony counts of controlled substances-fraudulent practices and six misdemeanor offenses.
Goupstate reported the arrest of Natalia Mikhailovna Roberts, a caregiver at Lake Emory Post Acute Care in Inman, S.C. Roberts is accused of taking medications from patients and charged with two counts of violating drug distribution laws and theft of a controlled substance.
Warrants from the Department of Health and Environmental Control accuse her of intentionally taking doses of hydrocodone and oxycodone that were intended for patients.
In one incident on May 27, records reflect that there were 78 doses of oxycodone for a patient when there should have been 96 tablets remaining, according to a warrant.
Another warrant states that on June 17, a page was missing from a controlled medication utilization record for another patient regarding hydrocodone doses.
Until a few months ago, Lake Emory was designated as a Special Focus Facility and was even fined almost $200,000 on Jan. 11, 2017. Lake Emory is owned and operated by Fundamental Long Term Care now known as Hunt Valley Holdins, a national for-profit chain with hundreds of nursing homes in numerous states.
The Columbus Dispatch reported that Eric Banks was accused of causing a fatal overdose by selling fentanyl to a resident of Manor at Whitehall Nursing Home. Banks has been indicted for involuntary manslaughter and other charges. In addition to involuntary manslaughter, Banks was indicted on one count of corrupting another with drugs and two counts of aggravated trafficking in drugs.
Prosecutor Ron O’Brien said Banks went to the Manor at Whitehall Nursing Home on Feb. 10 and sold fentanyl, a powerful synthetic opioid, to Dale Rogers, 56. Nursing staff found Rogers unresponsive, started CPR and called 911. Whitehall medics administered Narcan, which can reverse the effects of an opioid overdose, and took him to a hospital, where he was pronounced dead.
Rogers had texted an order for ”‘Chinese food’, which is slang for heroin, fentanyl or a mixture,” O’Brien said. Investigators found that Banks was the recipient of the text.
Toxicology tests on Rogers and lab work on drugs that investigators found on Banks all came back as fentanyl, O’Brien said.