In the past, the use of psychopharmacological medications, such as antipsychotics, has been widely accepted to address behavioral problems of residents in nursing homes. They are especially common among residents who show behavioral or psychological symptoms of dementia (BPSD). Unfortunately, these medications often do little to address the source of negative behaviors. In fact, many behavioral problems are caused by one or more of the following problems:
It is important to first diagnose the cause of behavioral problems before determining how to treat them. The use of medications as a primary form of treatment is alarming. Drugs may be viewed as a ‘quick fix’ to a surface-level problem, when a more thorough and holistic approach could address the underlying cause of an individual’s behaviors.
This personalized, patient-centric approach reduces the prevalence of psychopharmacological treatments and reduces the rate of related adverse events and complications, such as movement disorders, cerebrovascular accidents and increased risk of death. Even the FDA warns against the use of antipsychotics in aging patients with dementia, saying that, “Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo.”
Nursing homes are under regulatory obligation to adhere to F-Tag guidelines, particularly F-329 – ‘Free from Unnecessary Drugs’. F-329 is perhaps the most important F-Tag against inappropriate antipsychotic drugging.
It requires the following:
“Residents who haven’t used antipsychotics are not given them unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed/documented in the clinical record.
Residents who use antipsychotics receive gradual dose reductions, and behavioral interventions (unless clinically contradicted) in an effort to discontinue these drugs.”
Another F-Tag, F-309, is ‘Necessary Care for Highest Practicable Well Being’. As the name implies, this rule requires that residents be provided with the highest quality physical, mental and psychosocial services to ensure patient well being. It warns against the use of unnecessary drugs, stating that:
“Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:
Based on a comprehensive assessment of a resident, F-309 also states that skilled nursing facilities must ensure that:
“Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record
Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.”
Finally, F-222, the ‘Right to be Free from Chemical Restraints’, helps ensure that all residents are granted the right to freedom from any type of physical or chemical restraints – including antipsychotic medications – when those restraints are used for the purpose of discipline or convenience. Violation of this rule includes the administration of antipsychotic medication for any purpose other than as require to treat medical symptoms.
At Brighter Day Health, we are familiar with the regulations and guidelines nursing homes must abide by. Our commitment is to provide a quality of care that meets these restrictions and helps our clients remain in compliance with F-329 and other regulatory guidelines. For more information about how we work to reduce the use of antipsychotic medications in skilled nursing facilities, contact our office to speak with one of our helpful representatives.