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Re-Education
Starts with Self
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The problem is an expression of an un-met need –
a communication that challenges
you to understand.
“Surveyors are strongly advised to speak with the practitioner/prescriber and/or consultant pharmacist in cases where an antipsychotic
medication is prescribed for an elderly resident with dementia.”
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AHRQ Pub. No 11-EHC087-1 www.effectivehealthcare.ahrq.gov/reports/final.cfm
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MUST
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• Psychosis (in the absence of dementia)
• Tourette’s disorder
• Huntington’s disease
• Hiccups (not induced by other medications)
• Nausea and Vomiting associated with cancer or chemotherapy
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• Insomnia
• Uncooperativeness
• Verbal expressions and/or behaviors that do not present danger to the resident or to others
symptoms present a danger (and one or both the following)
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Monitoring of all Psychoactives
•Review continued need at least quarterly
•Document rationale for continuing •Resident’s target symptoms •Effects of the medication(s)
• Benefit vs. Risk
•Changes in resident’s function •Medication-related adverse consequences
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“If an antipsychotic is identified as probably causing or contributing to adverse consequences as identified
above, the facility must act upon this. The facility and prescriber must document the rationale for the decision to continue therapy, and also that the resident, family member, or legal representative is aware and involved
in the decision to continue the medication.”
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Generic Name Brand Name Half-Life
Aripiprazole Abilify 75 hours
Olanzapine Zyprexa 30 hours
Quetiapine Seroquel 6 hours
Risperidone Risperdal 20 hours
Ziprasidone Geodon 7 hours
Reinvent Yourself First the Team Second
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• Pharmacist • Care Plan • Nursing • Social Services
Pharmacist Nursing Social Services TEAM MEETING
Pharmacological Therapy Targeted Symptoms Meeting Lead The Main Event
• Start Date • Frequency/Intensity • Reason for Review • Evaluate Targeted Behaviors
• Directions for Use • Non-Pharmacological • BIMS/PHQ-9 • Evaluation of “Danger”
• Indication for Use • PRN Utilization • Prescriber Identification • Identification of Precipitating Events
• History of Therapy • Staff Education • Care Plan Review • Evaluate for Dose Reduction
• Adverse Drug Effects • Documentation Review • Recommendations
• Signatures
• Prescriber Review
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• Brenda Groves – Kansas Johnathan Reeves – Kansas
[email protected] [email protected]
• Krystal Hays – Nebraska
• Michelle Laukner – North Dakota
• Lori Hintz – South Dakota
Website: www.greatplainsqin.org
