Helpful Ideas

Problem: OSCAR reports are great for broad benchmarking, but not for facility-specific or facility-to-facility medication use comparisons.

Solution: Consultant pharmacists can provide client facilities with a sharper picture of residents' medication status relative to state and national trends by using the OSCAR approach to collect facility-specific data.

Since 1995, the Health Care Financing Administration has monitored nursing home psychotropic medication use and other indicators of resident health and well-being through its OSCAR (Online Survey Certification and Reporting) database. OSCAR data are collected on HCFA Form 672 (Resident Census and Condition of Residents) and other federal forms at the time of the annual facility survey, then forwarded to HCFA by state surveyors and disseminated in quarterly reports.

The domain of OSCAR data collection was recently expanded to include overall regulatory compliance summaries and comparisons of a facility's most recent survey data with state, regional, and national average (TCP, Vol. 12, No. 4, pp. 347-51).

"OSCAR reports provide a good snapshot of nursing home medication usage rates at the national, regional, and state level, but they can't tell you what's happening at a particular facility; the data analysis doesn't extend to the level of the individual nursing home," notes ASCP Director of Professional Affairs Tom Clark. "Consultant pharmacists, by virtue of their monthly drug regimen review activities, are in an excellent position to bridge that information gap."

To help pharmacists collect facility-specific data, Clark has developed a psychotropic reporting form (see next page). "Essentially, this form is designed to take the OSCAR process one step further, allowing the pharmacist to augment monthly or quarterly DRR activity reports with facility-specific medication use data." This additional data will produce a more useful, more meaningful report for facility administrators-and the pharmacy provider. The benefits of this approach are threefold:

• First, says Clark, "Presenting facility-specific data and OSCAR data side by side each month in a quick-reference format will make it easier for facility administrators to track psychotropic usage trends in their resident populations and conduct valid comparisons with OSCAR trends and averages."

• Second, "With this approach to data collection, the consultant pharmacist-not the nursing staff-is responsible for the quality of the data that goes into the OSCAR database," Clark says. Therefore, "the information provided to HCFA will likely be more accurate, and the resultant OSCAR reports will be more meaningful."

• Third, unlike some other systems for medication use monitoring, Clark's approach employs the same classification system used in OSCAR analyses; that is, medications are categorized by pharmacologic class, rather than intended use (e.g., Ativan, even when given for its hypnotic effects, is classified as an anxiolytic). "By speaking the same language as HCFA, you're enabling more valid OSCAR comparisons."

Part of the beauty of Clark's form is that all required information is readily available. The facility-specific data will emerge from monthly DRR reports. Cumulative 1996 OSCAR data is available on ASCP's Internet home page (www.ascp.com select "ASCP News"). Information on obtaining quarterly OSCAR reports can be obtained from state survey agencies.

The form Clark developed can be expanded to include a range of other OSCAR variables: rates of antibiotic and analgesic use; pressure sore incidence; incidence of behavioral symptoms and other indicators of mental status; medication error rates; payer source; and most frequently cited survey deficiencies.

"By merging facility-specific data and OSCAR data and presenting it in a quick-reference format, everybody wins," Clark says. "The nursing home gets a new tool to facilitate longitudinal tracking of psychotropic use. Federal authorities get more reliable data on nursing home medication use. And consultant pharmacists get more accurate OSCAR reports-and a new way to highlight the positive impact of their interventions."

David K. Buerger
Associate Editor

Psychotropic Medication Use Report

Nursing facility/unit: _______________________________________________________

Consultant pharmacist: _____________________________________________________

Reporting period: __________________________ Date of report:___________________

	No. currently	Last reported	OSCAR	OSCAR
Psychotropic Class	receiving (%)	number (%)	state average	national average
Antipsychotic				17.1%
Antianxiety				14.8%
Hypnotic				5.2%
Antidepressant				21.9%
Any psychoactive				44.0%

Note: OSCAR national averages are for the reporting period January-December 1, 1996.