A Survey of the Prescribing and Administration of Drugs in a Long‐Term Care Institution for the Elderly

Abstract

The prescription and administration of drugs (especially of the neuroactive class) was observed in 131 patients in an extended care facility. The average number of neuroactive drugs prescribed (2.1) was distinctly different from the average number administered (1.3) because of the large number of pro re nata (prn) prescriptions. More neuroactive substances were prescribed for patients with superior mentation and minimal physical disability; the difference between low and high groups was 1.7 (mentation) and 2.8 (physical status). The most common neuroactive drugs prescribed were: 1) analgesics, 2) major tranquilizers, and 3) hypnotics. Questionable prescribing practices were demonstrated by the fact that 30 patients had prescriptions for 38 "not-recommended"drugs; 23 of these prescriptions were for propoxyphene compound. After requiring physicians to rewrite drug orders every thirty days, a survey made ten months later showed that there was a decline (0.8) in the number of drugs prescribed per patient and a slight increase (0.45) in the number of drugs administered. Professional drug surveillance is crucial for improving the therapeutic process. At least two modifications of current prescribing practices are recommended: 1) a record should always be made of the precise condition(s) under which a drug prescribed "prn" is to be administered; and 2) a strong effort should be made to reduce the total number of drug prescriptions. The results of this survey suggest that certain procedural matters necessitating change are not in themselves the most substantive factors in improvement. Present "third party" review mechanisms likely will not ameliorate the current situation. It will be necessary to implement complex organizational changes in most extended care facilities.

Mental and physical capacity and consumption of neuroleptic drugs in residents of nursing homes

“…The number of residents regularly taking neuroleptic drugs is high, with considerable variations between the institutions and with declining use with increase in age, findings which are stated in other studies (Beers et al, 1988;Ingman et al, 1975;Gilleard et al, 1983;Mann et al, 1984;Ray et al, 1980). The results also demonstrate that physicians with full-time engagement in geriatric medicine are more reluctant to prescribe drugs.…”

A study of antipsychotic drug use in nursing homes: epidemiologic evidence suggesting misuse.

“…Selected case histories of inappropriately treated patients are cited in the public forums'6' 17 but the medical literature contains only a few preliminary studies of the subject.' [8][9][10][11][12][13][14][15][16][17][18][19][20] Because the records kept in nursing homes are much less detailed than those in hospitals, the only reliable way to identify individual cases in which antipsychotic drugs were misused would be examination of patients in the homes. However, this obtrusive approach would be prohibitively expensive for a large population of patients.…”

Pro Re Nata Prescribing in a Population Receiving Palliative Care: A Prospective Consecutive Case Note Review

“…Some literature exists regarding the PRN use of psychotropic medications in mental health settings 4,5 and geriatric care, 6 as well as the use of analgesia in the postoperative period. 1,2 A variety of medications are commonly prescribed on a pro re nata (PRN) or "as required" basis 3 to respond to fluctuations in symptom levels, yet this practice in hospice and palliative care is poorly documented.…”