The Effects of Organizational Culture on Prescribing Patterns in Nursing Home Residents Suffering from the Behavioral and Psychological Symptoms of Dementi

The behavioral and psychological symptoms of dementia are a major problem in nursing homes. Interventions and management of these symptoms remains an issue of debate, especially regarding the off label use of atypical antipsychotics. Atypical antipsychotics are often the first line of treatment used in controlling the behavioral and psychological symptoms of dementia. However, the use of these medications is controversial due to the limited effectiveness they possess as well as the many safety concerns associated with their use. It is not clear why atypical antipsychotics continue to be prescribed for individuals with dementia that are suffering from psychological and behavioral symptoms related to this cognitive decline. Organizational culture has been suggested as one factor involved in the prescription of atypical antipsychotics. The prescribing culture of a nursing home may influence the use or lack of use of atypical antipsychotics to treat the behavioral and psychological symptoms of dementia. A nonexperimental study was completed to compare the use of atypical antipsychotics in nursing homes with the organizational culture of each home to determine if there was a relationship between specific types of culture and increased or decreased use of atypical antipsychotics. Therapists working in nursing homes within the East Texas area were recruited to complete organizational culture surveys of nursing homes. In addition, data on the use of atypical antipsychotics within each of these specific homes was gathered from the Centers for Medicare and Medicaid Services (CMMS). The two sources of data were analyzed in a nonexperimental format, using analysis of variance. In this study, it was found that no relationship existed between organizational culture and the use of atypical antipsychotics in the treatment of the behavioral and psychological symptoms of dementia. Based on these findings, the null hypotheses related to each of the three research questions, were not rejected. It is recommended that qualitative studies be conducted to gain further insight into how culture in nursing homes operates and how possible prescribing cultures may develop and exist within those nursing homes. Finally, it is suggested that further quantitative studies of more robust nature are completed in order to better explore the relationship between organizational culture and prescribing patterns of atypical antipsychotics.