OIG: 99% of Nursing Home Records Didn’t Properly Document Antipsychotic Drug Use

Nursing homes overwhelming fail to properly use and document antipsychotic drugs, finds a July 2012 Office of Inspector General (OIG) report, as more than 99% of the records it reviewed for senior residents in skilled nursing facilities receiving atypical antipsychotic drugs during the first half of 2007 lacked evidence indicating they met all Federal requirements for administering such medication. 

Out of 375 records reviewed for nursing care residents, 373 couldn’t fully document how they had met the requirements for the four-step process of facility resident assessments and care plans: resident assessment; consideration of the Resident Assessment Protocol for psychotropic drug use; development of a care plan; and planned interventions for antipsychotic drug use.

One-third of those records didn’t show evidence of staff compliance with Federal requirements regarding the first step, resident assessments. In 4% of records, nursing facility staff didn’t document consideration of the RAP for psychotropic drug use as required—the second step. 


A whopping 99% of records didn’t contain evidence of compliance with the third step’s requirements for care plan development, while 18% of records that listed care plan interventions for antipsychotic drug use didn’t contain evidence that those interventions, which are the fourth step, ever actually occurred. 

The extent of this noncompliance identified in the report, says OIG, suggests “increased risk” for an elderly nursing home population that’s already vulnerable, and made three recommendations to the Centers for Medicare & Medicaid Services:

  1. Improve the detection of noncompliance with Federal requirements for resident assessments and care plans
  2. Take appropriate action to address noncompliance with Federal requirements for resident assessments and care plans
  3. Provide methods for nursing facilities to enhance the development and usefulness of resident assessments and care plans forresidents receiving antipsychotic drugs
CMS agreed with all of the above recommendations, OIG notes, and has taken steps to strengthen guidance for surveyors to improve the detection of noncompliance with Federal requirements for resident assessments and care plans. The agency also plans on clarifying guidance regarding deficiency determinations and enforcement remedies, and has a “multidisciplinary” approach to reduce the unnecessary use of antipsychotic drugs in nursing homes. 

Written by Alyssa Gerace



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