ICU Staff "Not Neurologically Sophisticated"
A big problem is the use of anti-psychotics in the elderly treated in intensive care units, Caplan explains. "The people running the ICUs are not neurologically sophisticated, so that they don't pay as much attention to neurospsychological aspects. They would much rather look at computers and see blood gas levels and do imaging rather than examine patients neurologically," Caplan says.
Because hospitals are segmented, the people who take care of patients in ICUs don't follow patients afterwards, so they don't see the longer-term effects of these drugs, he says.
Often, a hospital physician's prescription follows a patient to a nursing home where their use is never re-assessed. Family or patient consent for the use of these drugs, required in many states, is often never obtained.
Consider recent developments giving this issue more attention:
The Centers for Medicare & Medicaid Services is under pressure to improve its claims processes for use of these 10 anti-psychotic drugs. In its report last May, the OIG said that over a six-month period ending June 30, 2007, "over 726,000 of the 1.4 million atypical anti-psychotic drug claims for elderly nursing home residents did not comply with Medicare reimbursement criteria."
"We know that the overuse of these kinds of drugs is not a sector- or setting-specific problem, and we look forward to teaming our long-term-care colleagues with other caregivers across the continuum to make a positive difference in how we as a health community at large care for patients with behavioral issues, particularly those with dementia."