In the state of Illinois, psychotropic medication cannot be prescribed without the informed consent of the patient, the resident’s guardian, or other authorized representative. However, the practice of administration based solely upon a physician’s order without your consent is sadly, common. As your father’s guardian, you may be contacted regarding other needs, yet be unaware when new medications are prescribed. Worse yet, staff in some facilities are hesitant to be forthright when asked directly and specifically about the administration of a psychotropic drug, as family members typically have concerns …for very good reasons.
In 1997, a study performed by the Federal Dept. of Health and Human Services (OEI-06-96-00081) revealed that 15% of consulted pharmacists reported physicians prescribing inappropriate antidepressants to residents of skilled nursing facilities. All too often, this is the result of a direct request by nursing staff and without a proper evaluation by the physician. According to the report, “One-third say antidepressants are sometimes prescribed without an appropriate diagnosis and that few or no physicians ensure their maintenance at appropriate levels.”
Over-medicating is all too common, as many nursing homes fall short of the legally required documentation of medication administration. An alarming number of facilities operate without clearly enforced documentation policies. It’s often one of the common items noted as a violation during annual inspections.
The HHS study cited medication administration problems due to incomplete orders, failures to update administration records with current dosage schedules, and most importantly, failures to include orders on the medication administration record itself! Who administers psychotropic medication, when, and at what dosage is often absent from medical records, setting the stage for the all-too-frequent, over-dosing of a patient.
While nursing staff emphatically deny such occurs in their facility, it is often not the case, even within the most clean, beautiful and seemingly well-organized environment. As staffing levels decline in some facilities, psychotropic therapies often rise ensuring patients remain calm, quiet, and more easily managed.
Many resident-advocates today believe that little has changed, and that the use of psychotropic drugs continues to be a crisis unfolding.
Adverse reactions in patients that are being improperly medicated include:
- Urinary Incontinence
It is imperative that you, as your father’s legal power of attorney:
- Verify that a copy of your legal authority (Power of Attorney and/or Healthcare Power of Attorney) is present in your father’s chart. Ask to see it.
- Understand: you have a legal right to view your father’s chart upon request. Ask to review your father’s chart on a regular basis. You should be looking for any changes to medications (new medications and/or dosage changes of previously prescribed meds), as well as changes to diet, exercise, assistance needed, etc …things that might indicate that a new assessment should be done and changes to his care plan initiated.
- Find out which pharmacy fill prescriptions on behalf of your father and visit them. Provide the pharmacy with a copy of your power of attorney and ask for a printout of your father’s prescribed medication, including the dosage instructions. If the dosage levels are different from those on his medical record, ask for an explanation and documentation of a change ordered by the physician.
- If you sense that a sudden and/or significant change of consciousness has occurred and do not feel that the explanation offered by supervisors or other nursing home staff are adequate, call 911 and have your father transferred to an emergency room for evaluation by an independent physician. Request a toxicology screen be taken immediately so that the level of medication in the blood stream can be determined.
- Ask to review the medication list provided to the emergency room at the time of transfer. Often it will include medication that was not listed in the administration record shown to you. Also, ask the emergency room to provide you with a copy of the transfer documentation packet, which is legally required for all transfers of care – always get a copy of all the information provided.
Inappropriate administration of psychotropic drugs is dangerous and can result in life threatening injuries and illness if not managed properly. If you suspect that your loved one is receiving drugs without your consent, consult an attorney immediately. It may be your only guarantee that a thorough examination of the medical record can be obtained.