Antipsychotics tension enhances the attention

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James M. Berklan, McKnight's Editor
James M. Berklan, McKnight's Editor
If you feel like you've been bombarded with antipsychotic news lately, it's not in your imagination. People inside and outside of long-term care alike have been feeling the pressure to lessen antipsychotics' use in what has become a hot-button issue.

The federal government is both riding providers' own initiative, and digging its spurs into them. It wants to make sure something gets done about alleged overuse of chemical restraints.

Cheryl Phillips, M.D., LeadingAge's vice president for quality matters, recently wrote of the importance of decreasing unnecessary antipsychotic use. It's all about “getting a jump on nursing home quality,” she says. Check out her piece (with checklists) at

Also, Uncle Sam announced a new national initiative aimed at lessening “unnecessary antipsychotic use.” The kick-off to that was a March 29 video event that will remain viewable for a year at

And who do we have to thank for this heightened attention — and tension? Consumer advocates and Sen. Charles Grassley (R-IA), the latter of whom held a hearing on the topic last year and hasn't let go since. That has kept the fire stoked. And now CMS has put some bite in its growl, LeadingAge's Phillips acknowledged.

“I don't think anyone would say that 20% [the average of LTC residents on antipsychotics] across the country is a good number or the right thing. We can do better,” Phillips told me. “A push came from advocates, but at the same time, many providers have been working hard at the local level to do a better job with dementia care. Providers really believe they can do a better job.”

The American Health Care Association made one of its quality goals deal with antipsychotics, and the Advancing Excellence campaign also has taken the issue as one of its quality goals.

“All of these forces can be aligned for a common good,” Phillips says.

Before you get the wrong idea, don't think less antipsychotic use necessarily means more exorbitant staffing costs for more workers who need to keep an eye on more unpredictable residents.

Decreased antipsychotic use can mean staff have to spend less time with certain documentation, and residents are less likely to need as much help completing activities of daily living. At least that's providers' hope.