Winthrop University Hospital, Mineola, NY.
Department of Psychiatry, Division of Geriatric Psychiatry, NS-LIJ Health System, Manhasset, NY.
J Am Med Dir Assoc. 2011 Oct;12(8):573-577. doi: 10.1016/j.jamda.2010.04.005. Epub 2010 Oct 2.
To use a nationwide survey to assess changes in antipsychotic utilization patterns and usage policies in nursing homes (NHs) in the United States since the introduction of the black box warning by the FDA.
DESIGN/SETTING/PARTICIPANTS: A survey was distributed online and was completed by 250 directors of nursing of NH. The directors of nursing answered questions concerning policies about and use of antipsychotic medications.
MEASUREMENTS/RESULTS: The most commonly reported intervention to manage symptoms in residents with dementia since the black box warning was to lower doses of antipsychotics. Over half of facilities report obtaining more frequent psychiatry/psychology consults. One-hundred seven facilities have a policy regarding informing family members of residents about the black box warning. Most facilities (63.6%) with a policy require family to sign consent. In the NH setting, the presence or absence of a policy did not correlate with the reported change in use of antipsychotics or types of alternative interventions.
Notably, a large number of NH facilities have policies regarding informed consent on the use of antipsychotics. However, in our study, the rate of use of antipsychotics did not change in many facilities since the black box warning. In addition, having a policy did not correlate with decreased antipsychotic use or with use of alternate agents or nonpharmacologic methods to address symptoms. The results of this survey suggest that NH administrators should worry less about the legal exposure of using antipsychotics and focus on actions that result in improved patient care.
利用一项全国性调查，评估自 FDA 发布黑框警告以来，美国养老院（NH）中抗精神病药物使用模式和使用政策的变化。
设计/设置/参与者：在线分发了一项调查，由 250 名 NH 护理主任完成。护理主任回答了有关抗精神病药物使用政策和使用情况的问题。
测量/结果：自黑框警告发布以来，管理痴呆症居民症状的最常见干预措施是降低抗精神病药物的剂量。超过一半的机构报告称，更频繁地获得精神科/心理学咨询。有 107 家机构制定了有关告知居民家属黑框警告的政策。大多数（63.6%）有政策的机构要求家属签署同意书。在 NH 环境中，政策的存在与否与抗精神病药物使用或替代干预措施类型的报告变化无关。
值得注意的是，大量 NH 机构都有关于使用抗精神病药物的知情同意政策。然而，在我们的研究中，自黑框警告发布以来，许多机构的抗精神病药物使用率并没有改变。此外，有政策与减少抗精神病药物使用或使用替代药物或非药物方法来解决症状无关。这项调查的结果表明，NH 管理人员不应过于担心使用抗精神病药物的法律风险，而应关注能改善患者护理的行动。
