An indicator of appropriate neuroleptic prescribing in nursing homes.
OBJECTIVE
To derive and apply objective criteria which assess the appropriateness of neuroleptic prescribing, in a random sample of nursing homes.


METHODS
Cross-sectional survey of prescribing in a random sample of nursing homes.


METHODS
22 homes with more than 35 residents in the former South Thames Region.


METHODS
934 nursing home residents aged 65 years or over.


METHODS
We compared criteria of appropriate neuroleptic prescribing, including appropriate indication and review, to clinical data documented in the nursing and GP notes of residents prescribed neuroleptics.


RESULTS
Of the 229 (24.5%) residents prescribed neuroleptics, clinical notes were available for 225. Clinical data indicated that only 40/225 (17.8%) residents receiving neuroleptics received appropriate therapy. The intra-cluster correlations for appropriate and inappropriate prescribing of neuroleptics were 0.038 and 0.12 respectively. It was not possible to derive reference ranges of observed prescribing that included homes demonstrating appropriate prescribing whilst excluding those with inappropriate prescribing. Thus, clinical data are needed whenever neuroleptic appropriateness is assessed. Criteria were readily applicable in nursing homes.


CONCLUSIONS
Application of criteria of appropriate neuroleptic prescribing in a random sample of nursing homes identified suboptimal prescribing to elderly residents.
Oborne
C Alice
CA
Department of Health Care of the Elderly, Guys, Kings and St Thomas' School of Medicine, London, UK. alice.oborne@kingsch.nhs.uk
Hooper
Richard
R
Li
Ka Chi
KC
Swift
Cameron G
CG
Jackson
Stephen H D
SH
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000187:drug effects / Q000941:ethics*; D000465:Algorithms; D014150:Antipsychotic Agents / Q000592:standards / Q000627:therapeutic use*; D014487:Centers for Medicare and Medicaid Services, U.S.; D005260:Female; D019983:Guideline Adherence; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D006113:United Kingdom; D014481:United States
D014150:Antipsychotic Agents