Effect of the Omnibus Reconciliation Act 1987 on antipsychotic prescribing in nursing home residents

Abstract

Objective: To determine the impact of OBRA 87 on antipsychotic prescribing in a 485-bed nursing home.

Design: Twelve-month retrospective cohort review of medical charts, medication administration records, and computerized pharmacy records.

Measurements: The percent of residents by diagnostic group and antipsychotic use.

Main results: An attempt was made to stop or lower the dose of antipsychotic in 75% of the 107 residents studied. Antipsychotics were stopped in 45% of residents with a dementia-only diagnosis and 25% of residents with a psychiatric diagnosis (P < 0.05). Residents with documented symptoms appropriate for the use of antipsychotic, per OBRA 87, were significantly less likely to have their antipsychotic stopped. Twenty percent of residents whose antipsychotic was either stopped or its dose lowered had the agent restarted or its dose increased.

Conclusion: OBRA 87 had a significant impact on antipsychotic use in this facility.