Antipsychotic Medication Reduction: A Psychiatrist’s Pearls for Progress, Challenges and Continued Improvement

Welcome to the education module on Antipsychotic Medication Reduction: A Psychiatrist’s Pearls for Progress, Challenges and Continued Improvement provided by TMF Health Quality Institute. For assistance, contact Nursing Home staff at nhnetwork@tmf.org.

Credit Hours: 0.5 CME

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  • Overview
  • Accreditation
  • Disclosures
  • References

The purpose of this education activity is to enhance the knowledge and understanding of participating physicians and health care providers on the reduction of antipsychotic medication use in long-term care and mitigation strategies for challenges faced by the prescribing physician.

Learning objectives

After participating in this activity the participant will be able to:

  • Assess and evaluate appropriate antipsychotic medication use in nursing home residents.
  • Apply strategies toward behavior management and antipsychotic medication reduction.

Release Date: May 15, 2019
Expiration Date: May 15, 2020

Target Audience

This enduring material is designed for health professionals who would like to increase their knowledge on the need for reduction of antipsychotic medication use in long-term care settings and the challenges faced by the prescribing physician.

Accreditation Statement

TMF Health Quality Institute is accredited by the Texas Medical Association to provide continuing medical education (CME) for physicians.

TMF Health Quality Institute designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

TMF Health Quality Institute designates this CME activity for a maximum of 0.5 2A credits for Osteopathic physicians (DOs).

This CME activity has been designated by TMF Health Quality Institute for a maximum of 0.5 hours of education in medical ethics and/or professional responsibility.

Disclosures

The TMF Continuing Education Planning Committee and the presenter/authors of this module have no relevant financial relationships to disclose.

Planners: Terri Watson, Cayce Brewster, Hennie Garza
Presenters: Ellen Fan, MD

Policies and standards of the Texas Medical Association, the Accreditation Council for Continuing Medical Education and the American Medical Association require that speakers/authors and planners for continuing medical education activities disclose any relevant financial relationships they may have with commercial interests whose products, devices or services may be discussed in the content of a CME activity.

Notice of Requirements for Successful Completion of Continuing Education Activity:

To receive contact hours for this continuing education activity, the participant must:

  • Attend the session in its entirety to be eligible for continuing education credit. Click the "Start" button above to access the training video.
  • Upon completion of the training, provide a unique identifier (birth day and month).
  • Complete and submit the online Educational Activity Evaluation Form for this session.

Once successful completion has been verified, a “Certificate of Successful Completion” will be awarded for 0.5 contact hours.

 

The TMF web-based Continuing Education has received no commercial support.

Glossary of Terms

Commercial Interest: Any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients.

Conflict of Interest: The Accreditation Council for Continuing Medical Education considers financial relationships to create conflicts of interest in Continuing Medical Education (CME) when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. The potential for maintaining or increasing the value of the financial relationship with the commercial interest creates an incentive to influence the content of the CME—an incentive to insert commercial bias.

Enduring Material: An activity that endures over a specified time and does not have a specific time or location designated for participation; rather, the participant determines whether and when to complete the activity. Examples: online interactive educational module, recorded presentation, podcast.

Relevant Financial Relationships: Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria for promotional speakers’ bureau, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds) or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership and other activities from which remuneration is received, or expected. See also “conflict of interest.” Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Estimated Time to Complete this Educational Activity: 0.5 hour

References

National Partnership to Improve Dementia Care in Nursing Homes: Antipsychotic Medication Use Report. (January 2019). Retrieved from https://www.nhqualitycampaign.org/files/Antipsychotic_Medication_Use_Report.pdf

Davis, C. (September 2017). CMS Releases New MDS Rules [Section N]. American Association of Nurse Assessment Coordination LTC Leader. Retrieved from https://www.aanac.org/Information/LTC-Leader-Newsletter/post/testmanualupdates/2017-09-07

Levinson, D. (May 2011). Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents [PDF file]. (U.S. Department of Health and Human Services Office of Inspector General). Retrieved from https://oig.hhs.gov/oei/reports/oei-07-08-00150.pdf

National Partnership to Improve Dementia Care in Nursing Homes. (March 2019). (National Nursing Home Quality Improvement Campaign). Retrieved May 9, 2019 from https://www.nhqualitycampaign.org/dementiaCare.aspx

National Partnership to Improve Dementia Care in Nursing Homes. (March 2019). (Centers for Medicare & Medicaid Services). Retrieved May 9, 2019 from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.html

Brandt, N., Worz, C., Clackum, S. (June 11, 2018). Expanding Opportunities in the Postacute Long-Term Care Setting: Bringing Medication Safety to the Next Level. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 38(8), pages 862-866. https://doi.org/10.1002/phar.2155

Brodaty, H. et al. (July 2018). Antipsychotic Deprescription for Older Adults in Long-Term Care: the HALT Study. Journal of the American Medical Directors Association, Volume 19, Issue 7, pages 592-600.e7. https://doi.org/10.1016/j.jamda.2018.05.002

Burton, C., et al. (March 2018). Reduction of Off-Label Use of Antipsychotics in a Long Term Care Facility. Journal of the American Medical Directors Association, Volume 18, Issue 3, pages B21-B22. https://doi.org/10.1016/j.jamda.2017.12.067

Chiu, Y., Bero, L., Hessol, N., Lexchin, J., Harrington, C. (June 2015). A Literature Review of Clinical Outcomes Associated with Antipsychotic Medication Use in North American Nursing Home Residents. Health Policy, Volume 119, Issue 6, pages 802-813. https://doi.org/10.1016/j.healthpol.2015.02.014

Phillips, L., Birtley, N., Petroski, G., Siem, C., Rantz, M. (June 17, 2018). An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses. Journal of Psychiatric and Mental Health Nursing, Volume 25, Issue 8, pages 463-474. https://doi.org/10.1111/jpm.12488

Shaw, C. Williams, K., Perkhounkova, Y. (December 2018). Educating Nursing Home Staff in Dementia Sensitive Communication: Impact on Antipsychotic Medication Use. Journal of the American Medical Directors Association. Volume 19, Issue 12, pages 1129–1132. https://doi.org/10.1016/j.jamda.2018.09.030

Smeets, C. et al. (November 2014). Factors Related to Psychotropic Drug Prescription for Neuropsychiatric Symptoms in Nursing Home Residents with Dementia. Journal of the American Medical Directors Association, Volume 15, Issue 11, pages 835-840. https://doi.org/10.1016/j.jamda.2014.08.016

Resnick, B. et al. (July 2018). Reliability and Validity of the Care Plan Checklist for Evidence of Person-Centered Approaches for Behavioral and Psychological Symptoms Associated with Dementia. Journal of the American Medical Directors Association. Volume 19, Issue 7, pages 613-618. https://doi.org/10.1016/j.jamda.2017.10.021

State Operations Manual. Appendix PP—Guidance to Surveyors for Long Term Care Facilities. [PDF file]. (November 22, 2017). (the Centers for Medicare & Medicaid Services). Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Appendix-PP-State-Operations-Manual.pdf

MDS 3.0 Quality Measures User’s Manual v12. [PDF file]. (January 2019). (the Centers for Medicare & Medicaid Services). Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/MDS-30-QM-USERS-MANUAL-v120.pdf

Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review Critical Element Pathway. [Zip file]. (the Centers for Medicare & Medicaid Services). Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/LTC-Survey-Pathways.zip

F-Tag Crosswalk. [Excel file]. (the Centers for Medicare & Medicaid Services). Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/F-Tag-Crosswalk.xlsx