November 4, 2009

Dear Editor,

In response to your October 27 article “Drugged without cause,” Illinois nursing homes are dedicated to implementing psychotropic safety programs that protect residents from harm. We deliver 30 million days of care to more than 80,000 residents, and are responsible for safely administering more than a quarter of a billion prescribed medications a year. While mistakes can and do happen, nursing homes continue to strive to ensure that residents take their prescribed medications safely and effectively.

Illinois nursing homes follow stringent safety policies on the use of psychotropic medications that include the following:

· For any issue involving anxiety or tension, facilities must try other interventions first before considering a pharmacological approach;

· Before a resident is given a medication, the risks versus benefits must be evaluated;

· Resident quality of life is the most important issue and if the medication does not increase the quality of life, it must not be used;

· No psychotropic medication should be administered without the written consent of the resident or a guardian. Before beginning a medication regimen, facilities must educate residents and guardians as to the benefits and risks of a proposed psychoactive medication;

· Even if the residents’ physicians determine that there are benefits to prescribing psychotropic medications, facilities must monitor for adverse consequences and risks; evaluate the residents for fall risk; attempt gradual dose reductions; limit the time for certain drug categories; provide a monthly evaluation by the pharmacy review team; and closely monitor the residents’ behavior; and

· The facility’s Quality Assurance Committee must regularly review its protocol for administering psychotropic medications and recommend any improvements or changes for the benefit of the residents.

However, we also recognize some of the situations and incidents cited in the Tribune series need improvement. Although there are already many federal and state requirements with regard to the administration of psychotropic medication, we would support the establishment of a panel of medical, pharmacy, therapy and nursing experts established through the Illinois Department of Public Health to review the current practices in the prescription, administration and monitoring of the use of psychotropic medication.

We also recommend to our member facilities that, if they do not already have a quality assurance nurse reviewing every single situation of psychotropic medication use, that they devote the resources to this very important area of resident quality of life. A nurse specialist would ensure that proper resident education takes place, informed consent is correctly obtained, that a medication reduction program is planned and reviewed, and that side effects are monitored closely with care plan recommendations for improvement.

The Health Care Council of Illinois, an association of more than 600 nursing homes, is dedicated to educating our members about these important policies and making every effort to promote resident safety. Most of the public health violations on psychotropic medications are in regards to simple documentation errors that have no bearing on resident outcomes or well being. Although the profession we represent cannot be perfect, we are committed to providing our members with the most current policies, procedures and education programs to safeguard the 80,000 residents we serve and optimize their quality of life.

Susan Duda-Gardiner and Debbie Belt
Clinical Consultants
Health Care Council of Illinois