Why LTC Needs an Antipsychotic Stewardship Program
The GuideStar Eldercare Long-Term Care Antipsychotic Stewardship Program® is rapidly emerging as a successful, evidence-based clinical model for reducing the use of antipsychotic medications to treat Behavioral and Psychological Symptoms of Dementia (BPSD) in nursing home patients. Today more than ever, tackling overuse of antipsychotic medications is a mission-critical priority for nursing home operators—and for the safety and dignity of their residents.
Why it matters
More than 250,000 U.S. nursing home residents receive “dangerous antipsychotics” each week, and “in most cases, these drugs are administered without clinical justification,” concludes a report from the Long Term Care Community Coalition, “A Decade of Drugging”. (See the “Dangerous Antipsychotics” blog for background.)
CMS announced in January 2023 that it will be “conducting audits of schizophrenia coding in the Minimum Data Set data and, based upon the results, adjust the Nursing Home Care Compare quality measure star ratings for facilities whose audits reveal inaccurate coding.” Inaccurate coding can be the basis for antipsychotic regimens, and it puts patients at serious risk.
Antipsychotic drugs are dangerous for patients with dementia, carrying heightened risks of heart problems, falls, and death, explains the blog, Antipsychotic Drugs Overused in Nursing Homes.
Essential facts
More than 80% of LTC patients have a neurocognitive disorder. 95% of these patients have no history of serious mental illness, explained Drs. Posar, Shackson, and Heiser, GuideStar Eldercare presenters for the May 2023 session for the Ohio Health Care Association (OHCA), “New Concepts in Antipsychotic Stewardship.”
One in nine nursing home residents has a diagnosis of schizophrenia. But in the general population, the illness affects only about 1 in 150 people, reported the New York Times in 2021. The diagnosis has been broadly used in the industry to justify use of antipsychotic drugs.
Dementia care goals
The National Partnership for Dementia Care outlines these goals for the nursing home industry:
- Enhance the quality of life for people living with dementia
- Protect them from substandard care
- Promote goal-directed, person-centered care for every nursing home resident
- Increase the use of non-pharmacologic approaches and person-centered dementia care practices
Understanding the roots in neurology
Key to meeting these goals is recognizing that BPSD symptoms are not a primary psychiatric disorder, explained Drs. Posar, Shackson, and Heiser in the OHCA presentation.
To prevent or mitigate BPSD without chemical restraint, framing the challenge is important, they noted. It helps to understand that these are in neurologic (not psychiatric) patients with neurocognitive disease. That’s why accurate diagnosis is the cornerstone of care—and of clinical protocols for pharmacotherapy and other modes of treatment.
Forging a new paradigm
Operational issues are known to affect antipsychotic usage in nursing homes as well. Deprescribing can lead to positive outcomes and improved quality of living. Education, collaboration, and defining steps for clinical care are essential, explain Moth et al.
Read on to the next blog post to walk through the 6 Steps involved in antipsychotic stewardship.