PSYCHOTROPIC / PSYCHOACTIVE DRUGS ARE IN THE HEADLINES

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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.

CANNOT BE USED FOR DISCIPLINE OR CONVENIENCE

ASSESSMENT

• Nursing assessment on admission

• Change of Condition

• Documentation

WHY?

Improvement in quality of life for:

US? NO

Resident? YES

Roommate? NO

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 *

WEEKLY SUMMARIES

• Must reflect the use of psychoactive medications

• Effectiveness

• Side effects

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

QUALITY ASSURANCE - YOUR ROLE

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

QUESTIONS