Omnibus Budget Reconciliation Act (OBRA)
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Introduction
Established in 1987. It contained new fedreal rules for nursing home care. The goal of care is achieving the highest level of function.
The act requires that when a resident's condition deteriorates, documentation must show why the deterioration was medically unavoidable.
One of the mandates is comprehensible, reproducible assessment of all nursing home residents within 14 days of admission, including the 'minimum data set'.
Limits use of psychotropic medications
- domentation of necessity
- failure of behavior interventions
- redirection, distraction, environmental change
- patient a danger to self or others
- failure of behavior interventions
- at least 2 attempts of dosage reductions/year
- exceptions:
Appropriate diagnoses for use of antipsychotics
- schizophrenia
- schizoaffective disorder
- delusional disorder
- psychotic mood disorder
- acute psychosis
- brief reactive episodes
- schizophreniform
- atypical psychosis
- Tourette's syndrome
- Huntington's disease
- short-term treatment of hiccups, nausea, vomiting, pruritus
- agitation or psychosis associated with dementia or delirium
Inappropriate diagnoses for use of antipsychotics
- wandering
- poor self care
- restlessness
- nervousness
- uncooperativity
- anxiety
- fidgeting
- insomnia
- unsociability
- impaired memory
- depression without psychosis
- indifference to surroundings
- agitation not of danger to self or others
Additional terms
References
- ↑ Ouslander JG, Osterweil D. Physician evaluation and management of nursing home residents. Ann Intern Med 120:584, 1994 PMID: https://www.ncbi.nlm.nih.gov/pubmed/8116998
- ↑ Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004