An indicator of appropriate neuroleptic prescribing in nursing homes C. ALICE OBORNE,RICHARD HOOPER 1 ,KA CHI L I ,CAMERON G. S WIFT,S TEPHEN H. D. J ACKSON Clinical Age Research Unit, Departments of Health Care of the Elderly and 1 Public Health Services, Guys, Kings and St Thomas’ School of Medicine, London, UK Address correspondence to: C. A. Oborne, Pharmacy Department, Kings College Hospital, Bessemer Road, London SE5 9RS, UK. Fax: (q44) 207 346 3200. Email: alice.oborne@kingsch.nhs.uk Abstract 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. Keywords: nursing homes, antipsychotic agents, prescriptions, drug, quality of health care, quality indicators, health care Introduction Between 22% and 43% of nursing home residents in the United States and 24%–28% in the UK are pre- scribed neuroleptics [1–6]. In the nursing home sector, neuroleptics are frequently initiated for behavioural problems associated with dementia, but only about 18% of these patients respond [7]. Elderly patients are particularly prone to the adverse effects of neuroleptics [8]. The risk of falls and hip fractures is enhanced and confusion, cognitive impairment and poor motor performance may be exacerbated [8–11]. Longitudinal studies suggest neuroleptics increase the rate of cogni- tive decline and development of neurofibrillary tangles [12, 13]. There is evidence of inappropriate neuroleptic prescribing in nursing homes in the US [1–4], but fewer studies have evaluated prescribing appropriateness in UK nursing homes [5]. National consensus criteria, based on published evidence, regulate neuroleptic prescribing in the US nursing homes via the Omnibus Reconciliation Act 1990 (OBRA) [5]. None of the published data since OBRA have lead to the need for re-evaluation of these guide- lines. No such regulations are implemented in the UK, although Age Concern has produced similar guidelines [14]. We aimed to: 1. Develop an indicator of appropriate neuroleptic prescribing based on US OBRA guidelines. 2. Use this indicator to assess appropriateness of neuroleptic prescribing in a random sample of nursing homes. Age and Ageing 2002; 31: 435–439 # 2002, British Geriatrics Society 435