Nurse staffing and deficiency of care for inappropriate psychotropic medication use in nursing home residents with dementia

Abstract

Purpose: Psychotropic medications are used to manage behavioral symptoms of dementia in nursing homes despite limited efficacy and the risk of adverse effects, and may be considered an easier solution for the treatment of behavioral symptoms. However, non-pharmacologic interventions are preferable but are most effective with consistent staffing. To address this, the Centers for Medicare and Medicaid Services implemented additional regulatory scrutiny through F-tag for deficiencies of care, targeting inappropriate psychotropic medication use (F-758 tag). The purpose of this study was to examine associations between nurse staffing levels and the occurrence of deficiency citations for inappropriate psychotropic medication use in residents with dementia symptoms.Design: This was secondary data analysis of a cross-sectional study using CASPER (Certification and Survey Provider Enhanced Reporting) and PBJ (Payroll-Based

Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

“…(87) Likewise, total nurse staffing levels (all grades of nurse staff) and compliance were positively associated in eleven studies (36, 45, 51, 54, 87, 110, 111, 128, 153, 156, 158) , with two finding a negative association (49, 111) and three a null association. (37, 72, 84) The results are similar for nurse aides/care assistants: 15 studies reported higher levels these staff and compliance were positively associated (15, 35, 37, 48, 49, 51, 54, 56, 58, 79, 90, 126, 128, 138, 154, 156) , nine reported a null association (16, 52, 61, 88, 89, 110, 113, 120, 155) and three reported a negative association. (45, 47, 57) A higher ratio of registered nurses as against other nurse and care staff and compliance was positively associated in four studies (92, 93, 97, 138) with a null association in a further four.…”

“…Of the 29 studies examining registered nurse staffing, 19 reported higher levels of this staff grade and compliance were positively associated (15, 36, 47–49, 56–58, 79, 88, 90, 93, 113, 120, 138, 153–156) , nine reported a null association (16, 52, 61, 65, 92, 96, 124, 126, 157) and one reported a negative association. (87) Likewise, total nurse staffing levels (all grades of nurse staff) and compliance were positively associated in eleven studies (36, 45, 51, 54, 87, 110, 111, 128, 153, 156, 158) , with two finding a negative association (49, 111) and three a null association.…”

“…Of the 29 studies examining registered nurse staffing, 19 reported higher levels of this staff grade and compliance were positively associated (15, 36, 47–49, 56–58, 79, 88, 90, 93, 113, 120, 138, 153–156) , nine reported a null association (16, 52, 61, 65, 92, 96, 124, 126, 157) and one reported a negative association. (87) Likewise, total nurse staffing levels (all grades of nurse staff) and compliance were positively associated in eleven studies (36, 45, 51, 54, 87, 110, 111, 128, 153, 156, 158) , with two finding a negative association (49, 111) and three a null association. (37, 72, 84) The results are similar for nurse aides/care assistants: 15 studies reported higher levels these staff and compliance were positively associated (15, 35, 37, 48, 49, 51, 54, 56, 58, 79, 90, 126, 128, 138, 154, 156) , nine reported a null association (16, 52, 61, 88, 89, 110, 113, 120, 155) and three reported a negative association.…”

“…(36, 45, 48, 159) Higher levels of licensed practitioner/vocational nurses and compliance were positively associated in five (54, 56, 57, 70, 154) , negative in five (45, 47, 48, 51, 106) , and a null association reported in 13. (15, 49, 52, 58, 61, 79, 88, 89, 110, 113, 120, 138, 156)…”

“…(36,45,48,159) Higher levels of licensed practitioner/vocational nurses and compliance were positively associated in five (54,56,57,70,154) , negative in five (45,47,48,51,106) , and a null association reported in 13. (15,49,52,58,61,79,88,89,110,113,120,138,156) Higher specialist staff levels (e.g. dietary professionals) and compliance were positively associated in five studies (15,35,81,154,160) , negative in one (118) ; and null in two.…”