BEHAVIOR

AND PSYCHOACTIVE

MANAGEMENT PROGRAM

Tamra Hassler, RN, LHRM, CDP © copyrighted

Review F-329

Review Program

Review Procedure

Review Forms

Objectives

Unnecessary Drugs

1. General. Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:

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In excessive dose (including duplicate therapy);

For excessive duration;

Without adequate monitoring;

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Without adequate indications for its use;

In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or

Any combinations of the reasons above.

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2. Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that:

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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; and

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Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.

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Medications are an integral part of the care provided to residents of nursing facilities.• Diagnosing • Curing• Slowing Disease Process• Preventing Disease

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All medications must have a diagnosis or an indication.

We need to ensure through assessment and Monthly Pharmacy review that all are necessary.

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Therefore, as part of all medication management, it is important for the interdisciplinary team to consider non-pharmacological approaches.

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When is an evaluation warranted -

• Admission/re-admission

• A clinically significant change in condition/status;

• A new, persistent, or recurrent clinically significant symptom or problem

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When is an evaluation warranted -

• A worsening of an existing problem or condition;

• An unexplained decline in function or cognition;

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When is an evaluation warranted -

• A new medication order or renewal of orders; and

• An irregularity identified in the pharmacist‘s monthly medication regimen review

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Medication Monitoring –

• Through the care plan process

• Monitoring for adverse reactions

• Evaluating parameters

• Verify diagnosis or causes of signs and symptoms

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Sources of information to facilitate defining the monitoring criteria or parameters may include cautions, warnings, and identified adverse consequences from:

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• Manufacturers‘ package inserts and black-box warnings;

• Facility policies and procedures;

• Pharmacists;

• Clinical practice guidelines or clinical standards of practice;

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• Medication references; and

• Clinical studies or evidence-based review articles that are published in medical and/or pharmacy journals.

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Is the mediation at the correct dose?

Has the medication been prescribed for the correct duration?

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Tapering of a medication or Gradual Dose Reduction (GDR) –

• During monthly pharmacy review

• When evaluating progress

• During quarterly MDS

• Monthly Behavior-Psychoactive Management Program

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PROCEDURE:

Facility’s Behavior Management Program will consist of:

An effective Interdisciplinary Behavior Management Committee

Ensuring a thorough and comprehensive assessment of the resident’s needs, behaviors, and prior medication and medical history

PROCEDURE:

Monitoring the resident’s behavior(s) to establish patterns, determine intensity and behavior frequency, and identifying the specific (“targeted”) behavior(s) that are distressing to the resident which are decreasing the resident’s quality of life

PROCEDURE:

Thoroughly assessing the need for the inclusion of psychoactive medications into the resident’s medication regime

Along with the resident and their surrogate, weighing the risks and benefits of adding or eliminating psychoactive medications.

Planning and implementing appropriate interventions into the resident’s plan of care

PROCEDURE:

Evaluating the effectiveness of Pharmacological and non-pharmacological interventions

Monitoring for any adverse side effects of medications, which includes completion of Abnormal Involuntary Movement Scale (AIMS) as per recognized standards of practice

PURPOSE OF PROCEDURE:

To implement the most desirable and effective interventions that meet both the known and unknown needs of the resident, to change, modify, decrease, or eliminate behaviors that are distressing to the resident, and/or are decreasing or impacting on the residents’ quality of life.

PURPOSE OF PROCEDURE:

To increase desired behaviors, promote resident safety and security, and to enhance the resident’s ability to interact positively with his/her environment.

ROLE OF THE TEAM:

1. Meet monthly.

2. Review Residents receiving psychoactive medications at least quarterly for need to continue use.

3. Review admissions and readmissions of residents who are admitted with a psychoactive medication.

ROLE OF THE TEAM:

4. Educate themselves and appropriate Staff to understand the indications and goals for using the medication by obtaining a thorough resident history related to use of psychoactive medication.

5. Ensure that the facility staff provide effective monitoring.

ROLE OF THE TEAM:

6. The Behavior Management Committee will consist of at least the following:

Director of Nursing/designee Social Services – Committee Chair Consulting Pharmacist Nurse Manager(s) Activity Department Representative Dietary Representative (As determined by

Committee.)

ROLE OF THE TEAM:

7. The Behavior Management Committee will ensure the prescriber’s order for the dose of medication is based on the following:

Resident’s diagnosis Resident signs and symptoms Resident’s current condition, age, labs, and

other related tests

ROLE OF THE TEAM:

Co-existing medication regime Duplicate therapy does not occur unless

current standards of clinical practice and documented clinical rationale confirm the benefit

TAPERING AND GRADUAL DOSE REDUCTION (GDR)

Definition: GDR is defined as “the stepwise tapering of a dose to determine if symptoms, conditions, or risks can be managed by a lower dose or if the dose or medication can be discontinued.”

GUIDELINES FOR GDR

1. During the first year if receiving an antipsychotic or other psychopharmacologic medication, at least one attempt at GDR or dose tapering

2. A second attempt, in a subsequent quarter the same year (12 month period) unless the first attempt demonstrated that GDR or tapering was clinically contraindicated. The attempts should be at least a month apart.

GUIDELINES FOR GDR

3. After the first year, GDR or tapering should be attempted once a year.

4. GDR or tapering may be considered clinically contraindicated if the resident’s targeted symptoms worsened or returned during the reduction.

GUIDELINES FOR GDR

5. Residents receiving sedative/hypnotic medication routinely must have attempts to taper the medication during each quarter. Before tapering a dose of sedative/hypnotic is considered contraindicated for the remainder of that year, tapering must have been attempted during the previous 3 quarters and documented by the physician as unsuccessful.

Psychoactive Medication Consent Form

Psychotropic Logs Procedure Policy

FORMS

BEHAVIOR AND

PSYCHOACTIVE

MANAGEMENT PROGRAMWe thank you for your time today.

To learn more about this or to discuss services please contact Robin Bleier, RN, LHRM, CLC at robin@rbhealthpartners.com or visit

our web at www.rbhealthpartners.com

THANK YOU