Reducing Antipsychotic
Use in Long Term Care
April 2, 2015
Maine Nursing Summit
Tarsha Rodrigue, RN BSN, Clinical Nursing Supervisor
MaineGeneral Rehab and Long Term Care
Glenridge Living Community
A new day.
Aging Population/Incidence of
Dementia
• The geriatric population accounts for over
12% of the population in America but over
half of the hospital resources.
• 25% of hospitalized older adults have
dementia.
• 90% of people diagnosed with dementia will
have at least one or more behavioral
symptom.
A new day.
CMS Challenge
• At the end of 2011 Centers for Medicare and
Medicaid Services challenged nursing homes to
reduce the rate of antipsychotics in their facility by
15%.
• CMS used December of 2011 as baseline data for
the challenge. Nursing facilities would have one
year to achieve this goal.
• There are 3 approved diagnoses for use
A new day.
Challenge Accepted
• After researching the CMS challenge, and the
evidence against the use of these medications
our facility went into action.
• A committee was formed that included
primary nurses, nurse managers, our medical
director, administration and social workers.
• Our antipsychotic rate at Glenridge was
46.9% in December of 2011.
A new day.
Action Plan:
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Research
Build a Committee
Action steps into place
Education to staff and
families
• Evaluate
• Stay Passionate
• Stop Making Excuses
A new day.
Action:
 Each month every resident on an antipsychotic was
reviewed individually. Residents medications were
reduced slowly, in collaboration with the entire
team. Behaviors and mood were evaluated each
shift.
 A consent form was developed as education for
family members.
 Every resident in our facility on an antipsychotic for more
than 7 days will have education provided by a physician or
Nurse.
 Family Response
A new day.
Education:
 “Dementia Beyond Drugs” by Dr. Allen Powers was read
and discussed in a book club format.
 Education was provided at CNA meetings, Med Tech
meetings, License Nurse meetings with emphasis on
WHY and on Evidenced Based Practice.
 Specific residents have required Focus Groups that have
brought direct care workers together with Employee
Health.
 Our facility joined the Maine Partnership to Improve
Dementia Care. The purpose of the team is to reduce
the use of antipsychotic medications in LTC state wide.
A new day.
Education:
 We evaluated the required education for all staff in
Long Term Care.
 Dementia Training on Hire
 EASE Training biannually
 Several informal educational opportunities were
provided as well.
◦ Poster presentations in the break room with candy for staff.
◦ Information was included at Skills Fairs in the facility.
◦ An antipsychotic questionnaire was sent out with prizes to
staff that got answers right.
A new day.
Education: The Unmet Need
• What is the resident trying
to tell you by their
behavior?
• Individualized Care Plans
• Life Story
• Dedicated RN and CNA
Assignments
A new day.
Side Effects of Antipsychotics
• Blurred vision, confusion, constipation,
diabetes, dry mouth, drowsiness, effects on
motor control, headache, hypotension
(orthostatic), increased heart rate, intense
dreams, involuntary repetitive movements
(tardive dyskinesia: may be irreversible even
when the medication is stopped), lethargy,
muscle weakness, sweating, tremors, urinary
incontinence, retention and weight gain.
A new day.
Education: Myth Busters
• “The reduction task force is trying to reduce all behavior
medications for our residents”
• The risks of the medication is worth the benefits…
• Our residents NEED these medications to have quality of life.
• These medications help our residents with hoarding,
wandering, repetitive verbalizations, and yelling out
• These residents are violent….Someone is going to get hurt.
• There is nothing that the nurse can give the person when
they get agitated right now.
A new day.
Results
• In February of 2014 we reached a new low of 9.7%.
Our current rate March 2015 was 12.8%.
• Behavior incidents between residents has decreased
over 50% in the past 2 years.
• In 2012 we had an 11% reduction at Glenridge in
Reported Staff Incidents and Accidents. This was
maintained in the following years.
• Significant improvement in resident engagement,
interactions, and self care.
A new day.
Results
• In February of 2014 Glenridge was able to present
their positive outcomes to the Maine State
Legislature Department of Health and Human
Services Committee.
• In December of 2014 and January of 2015 Maine was
recognized as the #1 most improved state in the
nation.
• Our facility was asked to mentor other facilities in
Maine on successful reduction of antipsychotics.
A new day.
A new day.
Glenridge Antipsychotic Use: Tracking Our Success
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
A new day.
Increasing our Scope
• The Reduction Team at Glenridge has been tracking
admissions since July of 2012.
• 39% of residents are coming to our facility on an
antipsychotic.
• As a result of this trend:
– Ongoing work with the Maine Partnership to Improve
Dementia Care
– Education to Family Medical Institute physicians
– MaineGeneral Health was recently NICHE certified.
• Nurses Improving Care for Healthsystem Elders.
A new day.
Glenridge Admissions
• 45% of residents
have had
successful d/c
within 30 days
• 62% of residents
have had
successful d/c
within 90 days.
A new day.
Discontinued Antipsychotics within
90 Days
Bronze Award Recipient
A new day.
Conclusion
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Research-Stop Making Excuses
Utilize front line workers on your team
Put Action steps into place
Education: Make it fun
Evaluate
Stay Passionate
Celebrate
A new day.
Do the best you can until
you know better. Then
when you know better, do
better.
~Maya Angelo
A new day.
Resources:
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Powers, G. (2010). Dementia Beyond Drugs. Health Professions Press.
Briesacher BA, Limcango MR, Simoni-Wastila L et al. The quality of antipsychotic drug prescribing in
nursing homes. Arch Intern Med 2005; 165 (June): 1280-1285.
Rochon P, Normand S, Gomes T et al. Antipsychotic therapy and short-term serious events in older adults
with dementia. Arch Inter Med 2008; 168:1090-1096
Wang, P., Schneeweiss, S., Jerry, A., Fischer, M., & Mogun, H. (2005). Risk of Death in Elderly Users of
Conventional vs. Atypical Antipsychotic Medications. New England Journal Of Medicine. Retrieved from
http://www.nejm.org/doi/full/10.1056/NEJMoa05827
Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. (2005).
JAMA. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15687315
CMS Updates Survey Guidelines for Antipsychotic Drugs in Dementia Care. (2013, May 31). McKnight's
Long-Term Care News.
Schneider L, Tariot P, Dagerman K. Effectiveness of atypical antipsychotic drugs in residents with
Alzheimer’s disease. N Engl J Med 2006: 355;1525-1538
The American Geriatrics Society. (2012). American Geriatrics Society Updated Beers Criteria for Potentially
Inappropriate Medication Use in Older Adults. Journal of American Geriatrics Society. New York.
A new day.