PSYCHOTROPIC / PSYCHOACTIVE DRUGS ARE IN THE HEADLINES PRESENTED BY: LIZETH FLORES, RHIT, RAC-CT...
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Transcript of PSYCHOTROPIC / PSYCHOACTIVE DRUGS ARE IN THE HEADLINES PRESENTED BY: LIZETH FLORES, RHIT, RAC-CT...
PSYCHOTROPIC / PSYCHOACTIVE DRUGS ARE IN THE HEADLINES
P RE S E N
T E D B Y : L I Z E T H
F L OR
E S , RH
I T, RA C - C T
AN
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WHAT ARE PSYCHOTROPIC MEDICATIONS?
Also refereed to as:
• Psychotherapeutic Medication
• Psychoactive Medication
WHAT TYPE OF MEDICATIONS ARE USED IN SNF?
Antipsychotic Medications
• Commonly used to treat schizophrenia, these are the most powerful and dangerous of the psychotropic medications and require the use of allowable psychiatric diagnosis for their use in SNFs
Antidepressants
• Most commonly used, these medications are used to treat
depression
Antianxiety Drugs
• These medications are used to treat anxiety and can be used to treat behaviors that can cause danger to the resident or others or prevent the staff’s ability to care for the resident
Hypnotics
• Similar in chemical structure and pharmacological action to the antianxiety medications these are used to induce sleep.
DOCUMENTATION REQUIREMENTS
Documentation is key to ensuring facility compliance with state and federal
requirements for the use psychoactive medications
INFORMED CONSENT
• The attending physician determines capacity of the resident to make decisions and give informed consent on his/her admission orders or progress notes.
• If the resident is determined to not have the capacity to make informed decisions, a surrogate decision-maker is identified
• It is the physician’s responsibility to obtain informed consent for the use of psychoactive medications
INFORMED CONSENT
• When an order for a psychotherapeutic, physical restraint or medical device is obtained, the licensed nurse verifies with the physician that informed consent has been obtained.
The nurse may facilitate access to the resident or provide information on the responsible party to the physician but
CANNOT be the one to obtain consent for the use of the psychoactive medication
HOW DO WE DOCUMENT VERIFICATION OF INFORMED CONSENT?
The nurse documents this verification on the order by stating
“Verified that informed consent obtained”
WHAT IF?
• Resident does not have capacity to make decisions (based on physician documentation)
• There is no family or responsible party
THE IDT CAN CONSENT FOR THE RESIDENT
EMERGENCY
• In case of emergency where the resident’s behavior poses a risk to him/herself or others -
WHAT OTHER DOCUMENTS ARE NEEDED?
• Complete physician’s order including verification of informed consent
• Care plan
• Psychotropic Risk & Benefits Form
• Gradual Drug Reduction Attempts
• Weekly Summaries
• Monthly behavior summaries
COMPLETE ORDERS
• Drug name / dosage
• Route
• Frequency
• Diagnosis for use
• Behavior manifestation
• Verification of informed consent
CARE PLAN
• Problem statement including behavior manifestation
• Measurable goals
• Non-pharmacological interventions
• Medications in use
• Side effects sticker
PSYCHOTROPIC RISKS AND BENEFITS FORM
• New order or increase in current order
• Complete by the licensed nurse (resident or responsible party)
• Resident or responsible party signs the form
• If reviewed by phone; 2 licensed nurses will verify the review and both sign the form
GRADUAL DRUG REDUCTION (OBRA)
Antipsychotic medication –
Within the 1st year in which resident is admitted on an antipsychotic medication or after the facility has initiated a new medication
• In two separate quarters (with at least one month between the attempts)
• After the 1st year – annually
* Unless Clinically Contraindicated *
GDR
Antianxiety and Anti-depressant medications –
During 1st year of admission on these medications or a new order
• In two separate quarters (with at least one month between the attempts)
* Unless Clinically Contraindicated *
GDR
Sedatives / Hypnotics –
For as long as the resident remain on a sedative/hypnotic that is used routinely and beyond the manufacturer’s recommendations for duration of use
• Quarterly
* Unless Clinically Contraindicated *
MONTHLY BEHAVIOR SUMMARIES
• Monthly psychotropic summary sheet
• Must be available for physician review
• Progress Notes section of the chart
SURVEY ISSUES
• Big focus on informed consent • Multiple F-Tags • Documentation of interventions prior to
medication • Care planning
YOUR ROLE
Routinely monitor documentation for compliance with CV
policies and regulatory requirements
Daily telephone order review Daily COC audit Admission Audit Monthly Psychotropic Audit Monthly review of behavior summary sheets Weekly summary audit
ACTION PLANS
Find the appropriate policies
Maintain compliance with routine audits
Ensure complete documentation
Identify facility trends and present them at CQI