An indicator of appropriate neuroleptic prescribing in nursing homes

Objective: to derive and apply objective criteria which assess the appropriateness of neuroleptic prescribing, in a random sample of nursing homes. Design: cross-sectional survey of prescribing in a random sample of nursing homes. Setting: 22 homes with more than 35 residents in the former South Thames Region. Subjects: 934 nursing home residents aged 65 years or over. Methods: we compared criteria of appropriate neuroleptic prescribing, including appropriate indication and review, to clinical data documented in the nursing and GP notes of residents prescribed neuroleptics. Results: of the 229 (24.5%) residents prescribed neuroleptics, clinical notes were available for 225. Clinical data indicated that only 40/225 (17.8%) residents receiving neuroleptics received appropriate therapy. The intra-cluster correlations for appropriate and inappropriate prescribing of neuroleptics were 0.038 and 0.12 respectively. It was not possible to derive reference ranges of observed prescribing that included homes demonstrating appropriate prescribing whilst excluding those with inappropriate prescribing. Thus, clinical data are needed whenever neuroleptic appropriateness is assessed. Criteria were readily applicable in nursing homes. Conclusion: application of criteria of appropriate neuroleptic prescribing in a random sample of nursing homes identified suboptimal prescribing to elderly residents.