Quality PillarBy: Cathy McKay, RN, CRN, DON
Director of Nursing Services
Lakewood Continuing Care Center, Waterville, ME
The Centers for Medicare and Medicaid Services (CMS) identified reducing the off-label use of antipsychotics in nursing facilities as a top priority in 2012. With the help of our dedicated nursing staff, physicians, our consultant pharmacist, and support from administration, Lakewood has achieved excellent results in this national goal. The national average was scored at 24%, the state average 27.2%, our top performing peers at 20.30%, and Lakewood scored a remarkable 7.2%.
We’ve implemented several steps to make progress on this goal:
- There is no role for use of these medications on an as-needed basis only since it takes 3-7 days before the antipsychotic effect starts.
- Use of these meds for three months or more is assessed for discontinuation or gradual dose reduction.
- Patients admitted on these medications without a clear indication or on low dose are given a trial off these meds.
- We implemented a review process to ensure that all antipsychotic scripts are critically evaluated soon after they are written.
- What was done to try to figure out why the resident is having behaviors?
- What might the resident be trying to communicate to us (an unmet physical, emotional, or psychosocial need)?
- What do we believe the reason was for the resident's behavior (many times the answer is found in staff approach)?
- And, what alternate approaches were tried before requesting these medications?
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