Nursing Home Antipsychotic Use is Still an Issue, Says the Media.

Last year’s CMS initiative to reduce antipsychotics in nursing homes by 15% by the end of 2012 came on the heels of the scathing OIG Report on the prevalence of atypical antipsychotic drug use in nursing facilities and created plenty of news. The past few weeks have seen a surge in media coverage of nursing homes where antipsychotic drug use is still too common, providing us with the opportunity to give you a few brief compliance reminders.

Some things you need to think about:

Key points on the survey process from the CMS January 31, 2013 Call: Improving Dementia Care and Reducing Unnecessary Use of Antipsychotic Medications in Nursing Homes
- Surveyors will be looking at the systems and processes that your facility is using to determine the underlying causes of behaviors in residents with dementia.
- They will also be checking that care plans for residents with dementia that address behaviors. As we noted in our October 2012 blog entry “5 Things You Need to Keep in Mind to Manage Behaviors,” we discussed the importance of including the resident, family members and/or legal representatives in the process to get their input.
- Another area where surveyors will be focusing is on reviewing whether antipsychotic medications prescribed for an “urgent” situation are still necessary and have been evaluated by the primary care team. Documentation should provide strong evidence for the use of a chemical restraint in these situations.
- An F-329 citation can trigger a large number of potential association citations, including:
  - F-157 – Notification of Accidents/Changes/Transfers
  - F-154 & F-155 – Notice of Rights and Services and Free Choice
  - F-272 – Comprehensive Assessments
  - F-274 – Resident Assessment when Required
  - F-279 & F-280 – Comprehensive Care Plans
  - F-281 – Professional Standards of Quality
  - F-282 – Care Plan Implemented by Qualified Persons
  - F-310 – Decline in ADLs
  - F-315 – Urinary Incontinence
  - F-319 – Mental and Psychosocial Functioning
  - F-325 – Nutritional Parameters
  - F-327 – Hydration
  - F-385 – Physician Supervision
  - F-386 – Physician Visits
  - F-520 – QA Committee
On March 29, 2013, CMS will launch a new initiative to improve behavioral health and reduce the use of antipsychotic medications in nursing home residents. More information can be found on the CMS website.