Summary: GAO reported on the inadequacies in the medication review process established by the Department of Health and Human Services (HHS) to better assure the health and safety of patients. Under the nursing home standards, a monthly review is required of patient medications by a pharmacist or registered nurse. Analysis of the medication review process showed that: (1) HHS has not provided adequate information on monitoring and usage of drugs, particularly the frequency with which tests should be performed; and (2) HHS has not provided adequate medication review guidelines to pharmacists and nurses. Additionally, GAO found that: (1) pharmacists making medication reviews at many of the nursing homes were also filling prescriptions for the patients; (2) pharmacists and registered nurses charged with making medication reviews relied heavily on information shown on drug labeling; (3) a high percentage of patients taking certain drugs were not receiving recommended tests under the most liberal available criteria for frequency; (4) in a few instances, patients either received combinations of tranquilizers or sedatives which a professional standard review organization characterized as inappropriate utilization or had medical conditions which should have precluded the use of certain drugs; and (5) the scope of review described by about half of the pharmacists reviewed was less than that suggested by a professional standards review organization's training materials. To correct the inadequacies, GAO believes that HHS needs to establish minimum standards for the scope of coverage in the medication review and to assure that medication reviewers are apprised of acceptable review methodology.
