Nursing homes expected to miss 15% antipsychotic reduction goal, but officials focus on progress

Skilled nursing facilities are making progress in reducing the off-label use of antipsychotics but are expected to fall far short of an overall 15% reduction goal.

Facilities have averaged around a 4% reduction, said Alice Bonner, Ph.D., R.N., the director of the division of nursing homes of the Centers for Medicare & Medicaid Services. The agency and the American Health Care Association had aimed for facilities to achieve a 15% reduction by the end of 2012.

The good news is that use is going down steadily in every region, Bonner said Monday at the LeadingAge Peak conference in Washington, D.C. Leading Age quality vice president Cheryl Phillips, M.D., noted that some facilities have individually achieved up to a 50% reduction rate in the use of antipsychotics. Bonner, Phillips and Joseph Isaacs, the executive director of the Advancing Excellence in Long-Term Care Collaborative, led a session on national initiatives to improve quality outcomes. 

The CMS initiative debuted last year, shortly after AHCA made a 15% reduction part of its quality improvement plan for members. CMS has pushed for reductions due to what it says are higher-than-necessary disbursements of antipsychotics. In one quality measure/quality indicator report in 2010, CMS said 39.4% of residents nationwide who had cognitive impairment and behavioral issues but no diagnosis of psychosis or related conditions received antipsychotic medications.

The 15% goal was always ambitious, and progress is being made, stressed Greg Crist, an AHCA spokesman. 

“We know we are tracking in a positive direction,” he said. “We are optimistic but sober. If we don’t hit the 15%, we won’t throw up our hands in despair but continue to learn and collaborate.”

“Hand in Hand,” a CMS training packet on antipsychotic use, remains a great resource, Phillips noted. Additionally, an analysis of why a resident is on an antipsychotic can lead to a new solution. She gave an example of several residents on antipsychotics on a specific unit, including a resident who kept saying she was seeing dead babies in her room. That’s because the resident was hearing the squeak of a medication cart at night and believed it sounded like a baby in distress. 

“The solution wasn’t an antipsychotic,” Phillips said. “The solution was WD-40.”

The LeadingAge Peak conference concludes today.