A new study that explores deficiency-of-care citations in nursing homes offers a wealth of lessons on reducing overreliance on psychotropics in residents with dementia, according to researchers from Stony Brook University School of Nursing in New York, and the University of Maryland’s schools of nursing and of pharmacy.
The study team analyzed care citations for inappropriate psychotropics across 444 nursing facilities that received survey F-758 tags in the first quarter of 2018. In these cases, the deficiency citations flagged unnecessary use of psychotropics specifically in the care of residents with dementia.
Antipsychotics top the list
The F-758 tag citations most frequently involved antipsychotics medications, they found. And there were three common reasons surveyors cited facilities: failure to identify and/or monitor behavioral symptoms, failure to attempt gradual drug reduction and failure to maintain 14-day limitations on PRN psychotropic orders (medications not scheduled but taken as needed).
There were distinct differences in care issues depending on which drug a facility was cited for using unnecessarily. When compared to facilities whose citations did not involve antipsychotics, for example, those that used antipsychotics inappropriately were less likely to identify and/or monitor behavioral symptoms, attempt gradual drug reduction or provide adequate indications for psychotropics use.
The nursing homes with F-758 tags related to inappropriate anti-anxiety medication use, meanwhile, were less likely to maintain 14-day limitation on PRN orders or to provide residents with nonpharmacologic interventions.
Addressing these problems is a place to start when attempting to further reduce inappropriate psychotropics use for individuals with dementia, Jung Min Yoon, Ph.D., RN, of Stony Brook, and colleagues urged clinicians.
Training and cooperation needed
Along with correcting these issues, Yoon and colleagues recommended that facilities support the dementia care staff by providing comprehensive training in areas such as behavioral symptom assessment and monitoring and proper drug use guidelines. Ongoing coaching and mentoring are also important to help increase staff attitudes toward challenging resident behaviors, they added.
Finally, cooperation is needed between staff, clinicians and families to ensure proper outcomes with psychotropic medications are used, they wrote.
When a citation is given, “ongoing efforts should be made to develop strategies to successfully reduce inappropriate, unnecessary psychotropics use and minimize detrimental effects in those living with dementia,” the authors concluded.
Full findings were published in JAMDA.