Letter: Nursing home meds are scrutinized
"antipsychotic medications are not ordered for the convenience of the nursing home staff," writes Anthony Pignataro. Credit: Peter Kuper
Regarding "Chemical restraints" [Opinion, July 15], I am a pharmacist who has been privileged to work in several quality nursing homes. It's a regulation that the medical record of each nursing home resident must be reviewed by a pharmacist at least monthly. The article on chemical restraints was factually accurate, but there is another side to the story.
In a good nursing home, antipsychotic medication is ordered only after non-pharmacological interventions have been attempted and failed. The threshold for intervention is that a resident is a danger. Someone who doesn't rest or sleep, or who is physically aggressive toward other residents, falls into this category.
A psychiatrist is usually consulted before or immediately after an antipsychotic medication is ordered. The nursing home staff then monitors the resident for changes in behavior or side effects.
The pharmacist also pays careful attention to the use of antipsychotic and sedative medication. He or she will check whether non-pharmacologic interventions were attempted and whether a psychiatrist was consulted. The pharmacist will suggest periodic attempts to taper the dose to determine if a lower dose can be used, or if the medication can be discontinued.
In my experience, antipsychotic medications are not ordered for the convenience of the nursing home staff.
Anthony Pignataro, Huntington
