Medikamente als freiheitsentziehende Maßnahme in stationären Pflegeeinrichtungen? Eine kritische Analyse

Gleich, S.; Krüger, J.; Fels, H.; Skopp, G.; Musshoff, F.; Roider, G.; Schöpfer, J.; Graw, M. und Wiedfeld, C. (2020): Medikamente als freiheitsentziehende Maßnahme in stationären Pflegeeinrichtungen? Eine kritische Analyse. In: Rechtsmedizin, Bd. 31, Nr. 2: S. 101-109

Abstract

Background: Nursing home residents are predominantly multimorbid and suffer from dementia. This requires the facilities to provide labor-intensive care;however, at the same time there is a lack of nursing staff. An interdisciplinary working group conducted a study to investigate whether and what evidence exists for the use of psychotropic drugs as a custodial measure. Methods: The study included all residents of old age and nursing homes who died between 2013 and 2015 and were subsequently the subject of an autopsy at the Institute of Forensic Medicine in Munich. None of these cases harbored the suspicion of a drug overdose. Records from the state prosecutors office for each case as well as the macromorphological findings obtained during the autopsies were considered for data analysis. Chemical toxicological tests for drugs and narcotics were carried out in an accredited forensic toxicological laboratory by means of routine diagnostics. The evaluation of the collected data was performed descriptively with a statistics program. Results: The study included 98 residents of nursing homes, and current medication plans were available for 53 cases. In 37 cases there were deviations from the medication plan (on average 2 drugs per case). In 15 cases antipsychotics not prescribed at the time of death were detected and in 5 of these cases additional nonprescribed hypnotics/sedatives were also detected. Of the 53 cases with proven antipsychotics the medical indications for prescription was not comprehensible in 9 cases and of the 26 cases with hypnotics/sedatives in 8 cases. In 22 cases with proven antipsychotics the medication was administered in the evening, in 9 cases with hypnotics/sedatives in the morning. In the hair analyses antipsychotics were not only the most frequent group of active substances detected in the 3 months before death but also the most active substances per case, with an average of 3. Discussion: In our study we found several indications for the use of centrally acting drugs as custodial measures: for a large proportion of the hypnotics/sedatives and antipsychotics detected there was no comprehensible medical indication for their partly combined prescription. Substances with sedative properties predominated, antipsychotics were prescribed or dispensed in the evening, hypnotics in the morning. Furthermore, an unacceptably high number of centrally acting substances not prescribed by a physician was found, which is significantly higher than the results of the test reports of the medical service of the health insurance (MDK) in inpatient care. An even stronger effect was found in the analysis of hair samples.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0937-9819
• Sprache: Deutsch