Nursing leaders offered strategies to help nursing directors reduce antipsychotics use and alleviate alarm problems during a leadership panel Tuesday.

Doing 15-minute checks on each resident eliminated alarms at Saint Mary Home, said Aysha Kuhlor, RN, BA, a panel member and the facility’s director of nursing. The interactive session was held at the National Association of Directors of Nursing Administration/Long-Term Care conference in Nashville.

“There is no easy way of getting rid of alarms, and once they are on, the staff has this idea they can do less,” she told the 100 attendees. Once Saint Mary replaced its alarms with its check system, “the CNAs had to go to wherever the patient was. They increased their own supervision of the resident.”

A focus on antipsychotics reduction by the Centers for Medicare & Medicaid Services also was a big topic of discussion.

First of all, the mind-altering medications should be seen as a last resort, said Christine M. Osterberg, RN, BSN, a Pathway Health Services consultant. An initial assessment should evaluate a resident’s cognitive level, as well as her past lifestyle and level of medical stability.

Nurses also should consider a resident’s medical condition and look at whether undesired behavior is a result of irritability.
“Hungry, thirsty, not enough rest, too many things causing stress” — all can cause a resident to act out, Osterberg said. It’s also critical to carefully consider staff observations, she added.

“The latest guidelines on F-329 really talk about every nuance about that person’s past and whether current needs have been identified … The behavior has to be so dangerous that it’s worth the risk [of giving the medication],” Osterberg said.