Read the scope before the headline
HHS OIG reported in 2026 on CMS's 40 focused nursing-home inspections and described inappropriate antipsychotic use, missing safeguards, weak policies, and failures by medical directors and pharmacists. Because this was a focused inspection set, it should not be converted into a national failure percentage.
The report still matters directly to consultant pharmacists. OIG said pharmacists failed in some reviewed cases to identify medical concerns and recommend dose reductions. That finding directs attention to the substance and traceability of the regimen review, not simply whether a monthly note exists.
Audit one complete medication trail
Choose a small sample of residents receiving antipsychotics and follow each record from indication and target symptoms through nonpharmacological approaches, monitoring, pharmacist review, prescriber response, and subsequent reassessment. Record what is absent as carefully as what is present.
The purpose is not to second-guess an individual clinical decision from a dashboard. It is to find broken handoffs: an unclear indication, a recommendation without a response, a response without rationale, or a dose-reduction decision that never reaches the next review.
Ask whether the system preserves disagreement and follow-up
Software should make it possible to distinguish a recommendation, a prescriber or facility response, the rationale supplied, and the next action. A closed status by itself is weak evidence if nobody can tell why the item was closed.
Ask a vendor to demonstrate that chain with a realistic exception. The demonstration does not establish compliance or clinical quality; it shows whether the record can support the people responsible for those judgments.