The documentation of health problems in relation to prescribed medication in people with profound intellectual and multiple disabilities.
In PIMD homes only a large share of reflux-drug charts list a medical reason—check yours before the next med review.
01Research in Context
What this study did
The team pulled 105 medical charts from two Dutch homes for people with profound intellectual and multiple disabilities (PIMD).
They checked every prescribed drug to see if the chart listed a clear medical reason for it.
Two nurses scored each record; disagreements were solved by a doctor.
What they found
Only a large share of reflux-drug orders had a documented indication—the worst rate in the file.
Anti-seizure drugs did best at a large share. Overall, about one in three prescriptions lacked a written reason.
In short, the busier the medicine cabinet, the thinner the paperwork.
How this fits with other research
Lin et al. (2005) already showed big gaps between what directors call “important” preventive care and what really happens. Bigby et al. (2009) now pinpoints one gap: missing drug notes.
Robertson et al. (2017) found dysphagia is common in severe ID and often treated with reflux meds. The new audit shows those same meds are the least documented, so we may be treating a swallow problem we never properly assessed.
Faught et al. (2021) link poor outpatient documentation to higher preventable hospital stays for people with IDD. Together the papers form a chain: weak charting → questionable drug use → more ER trips.
Why it matters
If the chart does not say why a client gets omeprazole, you cannot tell if the drug is still needed, if the dose is right, or if behavior changes are side-effects. A five-minute chart sweep before the next doctor visit can flag missing diagnoses and spare the client unnecessary meds or hospital trips. Start with reflux and behavior-linked drugs; they are the most likely to be ghost-written.
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02At a glance
03Original abstract
BACKGROUND: Persons with profound intellectual and multiple disabilities (PIMD) suffer from a wide range of health problems and use a wide range of different drugs. This study investigated for frequently used medication whether there was a health problem documented in the medical notes for the drug prescribed. METHOD: Persons with PIMD with an estimated intelligence quotient of 25 and profound or severe motor disorders were studied. Data on health problems were taken from medical notes and prescribing data were obtained from pharmacies. Data covering 1 year were analysed. For four therapeutic areas (anticonvulsants, laxatives, drugs for peptic ulcer and gastro-oesophageal reflux disease and psycholeptics), we determined whether we could find an indication for prescribed medication. RESULTS: Some 254 persons with PIMD (46% male, 54% female; median age 49 years, range 6-82) from eight residential facilities participated. Some 226 participants (89%) were prescribed medication over the course of 1 year. An indication for the prescribed medication was documented for 92% (n = 130) (95% confidence interval 88-96%) of 141 participants on anticonvulsants, for 68% (n = 112) (61-75%) of 165 participants on laxatives, for 44% (n = 58) (36-52%) of 132 participants on drugs for peptic ulcer and gastro-oesophageal reflux disease, and for 89% (n = 102) (83-95%) of 115 participants on psycholeptic drugs. CONCLUSIONS: The best level of documentation was found for anticonvulsants the worst for drugs for peptic ulcer and gastro-oesophageal reflux disease. Lack of documenting an indication may be due to off-label use, inadvertent continuation of no longer indicated medication, inadequate documentation and underdiagnosis. Adequate documentation practices are essential because of the communication problems that are characteristic for persons with PIMD.
Journal of intellectual disability research : JIDR, 2009 · doi:10.1111/j.1365-2788.2008.01141.x