Medications Use and Patient Outcomes at Two Indianapolis Area Skilled Nursing Facilities: a Retrospective Chart Review

Background: Residential health care has changed over time. Skilled nursing facilities (SNF) as an alternative to standard long-term care are understudied. Objective: To describe current prescribing patterns of medication use in two Indianapolis SNFs.

Method: Chart review to examine associations between medication use and outcomes such as weight changes, falls and re-hospitalization. Discharged patients had to be residents for at least 14 days.

Results: 35 charts were reviewed. 17 (48.6%) patients were male, 22 (62.9%) were Caucasian, 15 (42.9%) had Medicaid, 6 subjects (17%) visited the emergency department, 5 (14.3%) visited the hospital during their stay at the selected facilities, 14 (40%) suffered falls, 23 (65.7%) took antidepressants, 15 (42.9%) received antibiotics and 4 (11.4%) had high anticholinergic burden. Duration of stay ranged from 14-362 days (median 41), age ranged from 40-95 (median 75), number of diagnoses 4-23, mean 12 (±4.105), weight change from loss of 52# to gain of 35.7# (median -5.6), Beer’s violations 0-3, mean 0.46 (±0.761) for patients aged ≥65 and the maximum scheduled medications at one time 3-24, mean 9.26 (±4.273). Of the 15 (42.9%) patients that received antibiotics there were 24 instances of use, 19 (79.2%) of those fit the facilities criteria for appropriate use of antibiotics.

Conclusion: There are few associations between exposures: use of antibiotics or antidepressants, anticholinergic burden, or deviations from Beer’s criteria. This may be due to small sample size or be an indication of careful prescribing at these facilities.