Skilled nursing facility (SNF) care is often challenged by the complex behavioral and psychological symptoms of dementia (BPSD). The utilization of antipsychotic medications has long been a focus in this context, with regulatory compliance and resident care being central concerns. While national initiatives have previously led to improvements in reducing antipsychotic rates, progress has slowed in recent times. To address this issue, a collaborative effort between an operator and neurobehavioral consultants was undertaken, aiming to implement interdisciplinary antipsychotic stewardship. This article will discuss the joint program’s approach in assessing and reducing antipsychotic use, as well as the results achieved through the implementation of clinical protocols.
What is Interdisciplinary Antipsychotic Stewardship?
Interdisciplinary antipsychotic stewardship refers to a collaborative approach between SNF facility staff and a clinical treatment team, including neurobehavioral consultants, to improve the care of individuals with BPSD. The goal is to ensure appropriate and evidence-based use of antipsychotic medications, while also exploring alternative strategies to address behavioral symptoms. This approach recognizes the importance of incorporating multiple perspectives and areas of expertise to optimize patient outcomes and minimize potential harms.
How Does the Joint Program Assess and Reduce Antipsychotic Use?
The joint program implemented a comprehensive assessment and treatment protocol to evaluate antipsychotic medication use and devise strategies for reduction when appropriate. The following steps were undertaken:
- Identification: All patients in three targeted buildings who were receiving antipsychotic medications were enrolled in the program.
- Multidisciplinary Evaluation: Diagnoses were reviewed by Clinical Psychology, Psychiatry, Consultative Gerontology (where indicated), and building Social Service. This holistic approach allowed for a comprehensive understanding of each patient’s needs and potential alternative interventions.
- Review of Behavioral Documentation: The team also examined behavioral reports for each resident to gain insights into their specific symptoms, triggers, and potential non-pharmacological interventions.
- Team-based Approach: A collaborative effort involving the clinical treatment team, facility staff, and pharmacy personnel was established to address polypharmacy (the use of multiple medications), all psychotropic medications, and specifically target antipsychotic reduction.
By ensuring a shared decision-making process and taking into account different perspectives, the program aimed to reduce the reliance on antipsychotic medications, while prioritizing the well-being of the residents.
What Were the Results of Implementing the Clinical Protocols?
The implementation of the clinical protocols resulted in significant reductions in antipsychotic use among the participating SNFs. Before the program’s full implementation in January 2021, the antipsychotic rates in the three buildings were 32%, 14%, and 18% respectively. Following the initial review, the rates remained similar to the baseline.
Quote: “After implementation of the clinical protocols, we found that the proportion of residents using antipsychotic medications declined to 9.6%, 4.2%, and 6.3% respectively.” (Posar et al., 2023)
This reduction represents a decrease of more than 65% in antipsychotic utilization, indicating the success of the interdisciplinary antipsychotic stewardship program. Notably, throughout the implementation process, no harms or clinical decline were observed as a result of discontinuing antipsychotic medications.
These findings highlight the value of a collaborative and evidence-based approach to care for individuals with BPSD. By leveraging the expertise of neurobehavioral consultants and involving all relevant stakeholders, SNFs can achieve substantial reductions in antipsychotic use, improving the overall quality of care for residents. It is crucial to acknowledge that antipsychotic medications may still have an essential role in specific cases and must be prescribed judiciously, but interdisciplinary antipsychotic stewardship offers a promising avenue for enhancing resident outcomes.
In conclusion, the implementation of a shared cooperative clinical protocol between SNF facility staff and a clinical treatment team demonstrated the potential to significantly reduce antipsychotic use without compromising patient well-being. This interdisciplinary antipsychotic stewardship program opens doors for further advancements in the care of individuals with BPSD and serves as an exemplar for the integration of best practices in pharmacology support.
Read the full research article: Interdisciplinary antipsychotic stewardship between operator and neurobehavioral consultant.
Disclaimer: While I have a passion for health, I am not a medical doctor and this is not medical advice.
Leave a Reply