Articles Posted in Medication Errors

Government regulators and lawmakers appear finally ready to do something about the widespread use of antipsychotics at nursing homes. These powerful drugs are often prescribed to residents diagnosed with Alzheimer’s or dementia by nursing homes hoping to sedate them. Not only are these drugs not an approved treatment for these conditions, but antipsychotic drugs also have a range of serious side effects and drug interactions. In the elderly, antipsychotic medications substantially increase the risk of falls. Sadly, the practice of prescribing dangerous, unnecessary antipsychotic medication is widespread in the nursing home industry. The federal government reports that approximately 16 percent of nursing home residents take antipsychotics.

Thankfully, the government appears ready to tackle widespread nursing home abuse. In a letter to US Centers for Medicare and Medicaid Services (CMS), the government agency responsible for regulating nursing homes, Rep. Richard Neil excoriates the nursing home industry’s illegal prescribing habits and the government agency for inadequate enforcement. Rep. Neil described instances of nursing homes who “falsified diagnosis” and failed to attain informed consent, all for the purpose of sedating a patient with unnecessary antipsychotics. The Democrat then sharply criticized CMS saying that “nursing facilities are getting away with this practice.” According to Rep. Neil, nursing homes are “neither being cited nor penalized.”

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Following several scathing investigations and reports, veterans’ groups are demanding better care at the nursing homes run by the beleaguered Department of Veteran Affairs. While public condemnation has mounted for the past few years over the VA’s ability to care for the country’s 20.4 million veterans, criticism of the nursing homes run by the government agency began last summer when a report found that 70 percent of the VA’s nursing homes received failing grades. Perhaps even worse, more than half of these nursing homes received the lowest grade possible. According to news organizations, the government has collected quality reports and grades for each nursing home run by the federal agency each year. Until the rankings leaked this year, the government had chosen not to publish the results.

In a follow-up investigation reported by The Boston Globe this week, news reporters found a VA nursing home filled with sleeping staffers and a closed cafeteria. Other examples the substandard level of care found at VA nursing homes include a veteran with undiagnosed scabies, a veteran who had sat in soiled sheets for hours, and a veteran writhing in pain because he had not received his scheduled medication, according to USA Today. The national newspaper also reported that a nursing home in Alabama declared a Navy Veteran dead after he simply walked out of a supposedly secure nursing home one night and did not return. Rege Riley, national commander of American Veterans, told USA Today that the “stories being reported about the treatment of some individual veterans at these facilities are nothing short of horrifying.”

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Medicare recently lowered the overall ratings of almost one-fourth of the country’s nursing homes due to insufficient staff levels. The move comes after Medicare adopted a new, objective measurement for staffing nursing homes. Previously, Medicare relied on unverifiable data submitted by the nursing homes. Medicare ratings, which can range between one and five stars, are provided for several categories of nursing home care, such as its rating of pressure ulcers or slip-and-falls, along with an overall rating for the nursing home. Medicare now gives the lowest rating, a single star, to 1,387 nursing homes across the country, according to The New York Times.

Medicare requires all nursing homes to have a licensed nurse working at all times and a registered nurse working at least eight hours every day. The payroll data submitted to Medicare by the nursing homes show that the registered nurse requirement produced the majority of compliance problems. Registered nurses, who have the highest level of training and education requirements, are typically able to provide medical services, such as diagnosing illnesses or prescribing medicine.

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According to the Kaiser Health News, an average of 21 percent of nursing home residents are readmitted to the hospital within 100 days of returning to their nursing home. Now, Medicare plans to crack down on these nursing homes who either allow nursing home residents to return too quickly or fail to properly administer the resident’s post-hospitalization care. According to Medicare, most nursing home patients are readmitted for mostly preventable problems, such as dehydration, bedsores, infections, and medication errors. While patient advocates believe there can be significant room for improvement in these re-hospitalization rates, they also caution against punishing nursing homes who send their elderly residents to the hospital.

According to a government report, cited by NPR, a full 10.8 percent of re-hospitalizations are preventable. The causes for the high rate of unnecessary hospitalizations are numerous. First, the nursing home may not follow the hospital’s post-hospitalization care routine for their resident. In one example cited by the news organization, nurses at a nursing home in North Carolina injected a patient with a blood thinner twice a day – despite written instructions from a hospital doctor to cease all blood thinning medication. The second cause concerns overloaded hospitals, which would prefer to offload patients onto nursing homes in an effort to free-up space for more patients.

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A recent report by StatNews shows that many nursing homes across the country are refusing to admit elderly Americans with opioid addictions, and failing to effectively treat those with addiction already placed in their care. According to the newspaper, elderly Americans who have been prescribed methadone or buprenorphine, medications commonly used to treat opioid addiction, face the “next to impossible” task of being admitted to a nursing home. According to experts cited by the newspaper, many facilities fail to admit these patients because “of stigma, gaps in staff training and a widespread misconception that abstinence is superior to medications for treating addiction.”

Nursing homes appear unaware that denying admission because of an opioid addiction violates the Americans with Disabilities Act. According to a nurse at Boston Medical Center, only two nursing homes in Boston accept patients taking medication for an opioid addiction. According to the Department of Justice, the government is planning to increase enforcement of facilities that discriminate against individuals taking prescription medication for opioid addiction. Currently, the government agency is looking at detention centers and prisons to ensure compliance. However, the Department of Justice has promised to extend the enforcement push to nursing homes within the year.

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Mirroring national trends, elderly Americans are beginning to use more addictive prescription drugs. In a report by the New York Times, the number of prescriptions for benzodiazepines, a class of anxiety drugs which includes Xanax and opioids have markedly increased in the last couple decades. Not only do these addictive drugs have serious side effects, they can be deadly to the user, sometimes even when taken as prescribed.

According to the newspaper, the number of benzodiazepine prescriptions for Americans over the age of 65 increased 8.7 percent between 2003 and 2010, the year with the most recent data available. A 2008 study indicated that about 9 percent of adults between 65 and 80 took one of these anti-anxiety drugs. The Centers for Disease Control (CDC) paints an even more ominous picture of the problem – the number of deaths caused by benzodiazepines in Americans over the age of 65 rose from 63 deaths in 1999 to 431 in 2015. In 1999, opioids were a contributing cause of 29 percent of these deaths. A mere fifteen years later, opioid drugs now contribute to two-thirds of deaths caused by benzodiazepines.

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