A common area of concern in skilled nursing facilities is treating dementia patients with antipsychotic medications. Health care professionals waver between the good effects of antipsychotics, alleviating symptoms of dementia, and the bad effects—including adverse drug events.
Advanced Rehabilitation and Healthcare of Vernon, a skilled nursing facility out of Vernon, Texas, struggled with this concern. Twenty-one of the 95 residents were on antipsychotics, and 13 of those residents were diagnosed with dementia. The facility started evaluating patients after realizing that 19 of the residents on antipsychotics were already on the medication upon admittance.
Misty Peterson, RN, director of nursing, explained, “Because antipsychotics are used to control ‘undesirable behavior,’ our staff was apprehensive to reduce the medications.” Facility leadership informed the staff about the side effects of the medications and, in the best interest of the residents, persuaded the staff to receive training to treat patients with dementia with alternative methods. In addition to educating nurses, the skilled nursing facility educates all departments, including housekeeping and dietary personnel.
Turning to resources provided by the Advanced Rehabilitation and Healthcare system and the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO), the skilled nursing facility was able to provide up-to-date resources and training for the organization’s staff. As part of the Nursing Home Quality Improvement Learning and Action Network through TMF QIN-QIO, nursing staff at Advanced Rehabilitation and Healthcare of Vernon viewed videos on root cause analysis and quality measures, downloaded worksheets for training on root cause analysis and received individual consultations on a monthly basis from TMF QIN-QIO quality improvement consultants.
After educating staff, the skilled nursing facility leadership introduced behavior charts for nurses to use to call out adverse behaviors demonstrated by the residents. The data collected from these charts helped the facility identify the root cause of resident behaviors. Using this information, the staff found alternatives to administering antipsychotics, such as reducing overhead noise in the facility and creating meaningful activities for residents.
Integration of behavioral health services was another step the skilled nursing facility used as an alternative treatment. All of the residents on antipsychotics were referred to Vericare, which offers psychological and psychiatric services for residents. Vericare also conducted on-site behavior training for the staff.
One resident was admitted while already on antipsychotics for aggressive behavior from dementia. She often yelled at other residents and was physically aggressive with her care team. From the root cause analysis, the care team was able to identify that her behavior escalated toward the evening and night. After consulting the TMF QIN-QIO, the team requested the patient receive pain medications before bed. Once her pain was under control, the team began to wean her off antipsychotics. With her cognitive functions clear again, she was able to communicate that her teeth were causing her pain, and a dentist confirmed a tooth infection. With the appropriate treatment, her aggressive behavior diminished.
Education for families is just as important as staff education. “Many of our families were surprised to hear of the side effects of antipsychotics,” said Peterson. Now, when a resident is admitted already on an antipsychotic medication, the facility attempts to educate the families and seek alternative solutions.
Advanced Rehabilitation and Healthcare of Vernon will continue to assess resident behaviors and educate staff. “The plan for our facility is fix it and sustain it,” said Peterson. “We strive to do for them what we would do for our own families.”
For more information about Advanced Rehabilitation and Healthcare of Vernon, please contact Misty Peterson, MPeterson@advancedrehabofvernon.com.
For more information about the TMF QIN-QIO Nursing Home Quality Improvement Learning and Action Network, please visit www.tmfnetworks.org, or email nhnetwork@tmf.org.
This material was developed by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. This content does not necessarily reflect CMS policy. 11SOW-QINQIO-C2-16-41