Magazine article Clinical Psychiatry News

Teams Help Reduce Psychoactive Drug Doses

Magazine article Clinical Psychiatry News

Teams Help Reduce Psychoactive Drug Doses

Article excerpt

LONG BEACH, CALIF. -- Using interdisciplinary teams in a systematic way can help nursing homes meet requirements that they stop excessive use of psychoactive medications in residents.

Three reports from the meeting showed how facilities are using interdisciplinary teams to comply with Federal Health Regulations for Long-Term Care Facilities rule 329 (F-Tag 329), which mandates that "each resident's medication regimen must be free from unnecessary drugs," and to comply with state regulations such as California's State Operations Manual Appendix PP, which requires consideration of gradual dose reductions to avoid unnecessary medications.

At a 230-bed long-term care facility in San Antonio, an interdisciplinary team approach reduced antipsychotic use by 74%, anxiolytic use by 23%, and stimulant use by 13% within 6 months, Dr. Kunle Adedeji and associates reported in a poster presentation.

The facility had been contracting with a psychiatry group to provide mental health services and collaborate with the medical director on all psychoactive prescriptions. The new interdisciplinary team included the facility's medical director, consulting pharmacist, director of nursing, nurse manager, Minimum Data Set coordinator, two social service representatives, and the consulting psychiatry group's nurse practitioner.

The team met monthly to review the cases of all residents who were prescribed psychoactive drugs within the preceding month. Members discussed concerns about each patient, made recommendations for reducing or discontinuing medications, and made sure that each psychoactive drug prescription had a specific diagnosis linked to it.

The use of antipsychotics had been slightly higher in the facility than state and national averages before the multidisciplinary team formed. But 6 months later, usage was down to 6% of residents, far below those averages, reported Dr. Adedeji of the University of Texas Health Science Center, San Antonio.

The team's efforts were supplemented by systematic implementation of non-pharmacologic treatments such as offering residents "busy boxes" or gardening to reduce agitation. The team implemented protocols for discontinuation of "as needed" medications for anxiety and sleep management. Floor staff underwent training in managing residents with dementia and behavioral problems.

Psychoactive Drug Doses Reduced

At a 150-bed skilled nursing facility in Hendersonville, N.C., 6 months of an interdisciplinary team approach reduced use of antipsychotics by 54%, reduced anxiolytic use by 54%, reduced the use of hypnotics more than twice per week by 64%, and decreased psychiatric discharges to hospitals by 72%, Mark Coggins, Pharm. …

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