Reducing Antipsychotic Use in Nursing Homes: A Paradigm Shift
A vast majority of nursing home patients with dementia will at some point develop behavioral and psychological symptoms of dementia (BPSD), and this is often the starting point of antipsychotic medication use. However, CMS guidance challenges the LTC to reduce antipsychotics, and the industry faces challenges to reducing antipsychotic use.
Neurologic patients - not psychiatric
The clinical leadership team at GuideStar Eldercare has been forging a paradigm shift in how we understand and solve the problem of antipsychotic overuse by first starting at the beginning, with an accurate diagnosis. “If the diagnosis is wrong, it can take you in the wrong direction,” explains Daniel Heiser, PsyD, Senior Vice President, Behavioral Health at GuideStar.
“These were normal individuals, living their lives, married, raising their kids, working, involved in their communities, their churches…and when they were diagnosed with dementia, everything changed.” Dementia causes a change in the individual’s brain at a neurologic level. These changes lead to Behavioral and Psychological Symptoms (BPSD) that express themselves as psychiatric changes, but because they are due to the neurological change, they need to be treated as such.
Once patients develop BPSD, “they begin to look very much like psychiatric patients, but they are not,” says Heiser. “They don’t do well when we put them in the psychiatric box and treat them accordingly.” Take a listen:
Antipsychotic stewardship
Equipped with this understanding and armed with multi-disciplinary care teams, GuideStar Eldercare has been forging a paradigm shift in how to reduce antipsychotic usage in nursing homes by focusing on the neurology in residents with dementia. GuideStar Eldercare Long-Term Care Antipsychotic Stewardship® is an evidenced-based program backed by clinical experience and research. Already, the model has helped facilities safely reduce their antipsychotic usage rates and polypharmacy, while supporting documentation and regulatory compliance.
Diagnosis, not just symptom response
A multi-disciplinary, neurology-forward approach to diagnosis and treatment is key to calibrating decisions about antipsychotic use. GuideStar Eldercare provides consultation with a neurology-forward approach, supported by highly trained Nurse Practitioners conducting bedside neurological screening. This is crucial, explains Anita Reid, MSN, APN, FNP-BC, GNP-BC, Senior Vice President, Nurse Practitioner Services, because pinpointing the diagnosis is the basis of appropriate and effective treatment at any point in time. “If a person is on an antipsychotic drug for a symptom, it is important to know what disease is causing that symptom,” she emphasizes. Take a listen:
Reid emphasizes that the program advances a facility’s compliance, noting that the “rules” of compliance are devised for the benefit of the residents. When we integrate proper diagnosis and care, looking at each patient as an individual, she says, “we see better clinical outcomes,” along with consistent documentation and a higher quality of care. Read the AAIC poster session on interdisciplinary antipsychotic stewardship to learn more, and get in touch if you’d like to explore an antipsychotic stewardship pilot in your facility.