1. PSYCHOTROPIC / PSYCHOACTIVE DRUGS ARE IN THE HEADLINES PRESENTED BY: LIZETH FLORES, RHIT, RAC-CT ANDERSON HEALTH INFORMATION SYSTEMS, INC. APRIL 16 TH, 2012

2. WHAT ARE PSYCHOTROPIC MEDICATIONS? Also refereed to as: Psychotherapeutic Medication Psychoactive Medication

3. WHAT TYPE OF MEDICATIONS ARE USED IN SNF? Antipsychotic Medications Commonly used to treat schizophrenia, these are the most powerful and dangerous of the psychotropic medications and require the use of allowable psychiatric diagnosis for their use in SNFs Antidepressants Most commonly used, these medications are used to treat depression

4. Antianxiety Drugs These medications are used to treat anxiety and can be used to treat behaviors that can cause danger to the resident or others or prevent the staff’s ability to care for the resident Hypnotics Similar in chemical structure and pharmacological action to the antianxiety medications these are used to induce sleep.

5. CANNOT BE USED FOR DISCIPLINE OR CONVENIENCE

6. ASSESSMENT Nursing assessment on admission Change of Condition Documentation

7. WHY? Improvement in quality of life for: US? NO Resident? YES Roommate? NO

8. DOCUMENTATION REQUIREMENTS Documentation is key to ensuring facility compliance with state and federal requirements for the use psychoactive medications

9. INFORMED CONSENT The attending physician determines capacity of the resident to make decisions and give informed consent on his/her admission orders or progress notes. If the resident is determined to not have the capacity to make informed decisions, a surrogate decision-maker is identified It is the physician’s responsibility to obtain informed consent for the use of psychoactive medications

10. INFORMED CONSENT When an order for a psychotherapeutic, physical restraint or medical device is obtained, the licensed nurse verifies with the physician that informed consent has been obtained. CANNOT The nurse may facilitate access to the resident or provide information on the responsible party to the physician but CANNOT be the one to obtain consent for the use of the psychoactive medication

11. HOW DO WE DOCUMENT VERIFICATION OF INFORMED CONSENT? The nurse documents this verification on the order by stating “Verified that informed consent obtained”

12. WHAT IF? Resident does not have capacity to make decisions (based on physician documentation) There is no family or responsible party THE IDT CAN CONSENT FOR THE RESIDENT

13. EMERGENCY In case of emergency where the resident’s behavior poses a risk to him/herself or others -

14. WHAT OTHER DOCUMENTS ARE NEEDED? Complete physician’s order including verification of informed consent Care plan Psychotropic Risk & Benefits Form Gradual Drug Reduction Attempts Weekly Summaries Monthly behavior summaries

15. COMPLETE ORDERS Drug name / dosage Route Frequency Diagnosis for use Behavior manifestation Verification of informed consent

16. CARE PLAN Problem statement including behavior manifestation Measurable goals Non-pharmacological interventions Medications in use Side effects sticker

17. PSYCHOTROPIC RISKS AND BENEFITS FORM New order or increase in current order Complete by the licensed nurse (resident or responsible party) Resident or responsible party signs the form If reviewed by phone; 2 licensed nurses will verify the review and both sign the form

18. GRADUAL DRUG REDUCTION (OBRA) Antipsychotic medication – Within the 1 st year in which resident is admitted on an antipsychotic medication or after the facility has initiated a new medication In two separate quarters (with at least one month between the attempts) After the 1 st year – annually * Unless Clinically Contraindicated *

19. GDR Antianxiety and Anti-depressant medications – During 1 st year of admission on these medications or a new order In two separate quarters (with at least one month between the attempts) * Unless Clinically Contraindicated *

20. GDR Sedatives / Hypnotics – For as long as the resident remain on a sedative/hypnotic that is used routinely and beyond the manufacturer’s recommendations for duration of use Quarterly * Unless Clinically Contraindicated *

21. WEEKLY SUMMARIES Must reflect the use of psychoactive medications Effectiveness Side effects

22. MONTHLY BEHAVIOR SUMMARIES Monthly psychotropic summary sheet Must be available for physician review Progress Notes section of the chart

23. SURVEY ISSUES Big focus on informed consent Multiple F-Tags Documentation of interventions prior to medication Care planning

24. QUALITY ASSURANCE - YOUR ROLE

25. YOUR ROLE Routinely monitor documentation for compliance with CV policies and regulatory requirements  Daily telephone order review  Daily COC audit  Admission Audit  Monthly Psychotropic Audit  Monthly review of behavior summary sheets  Weekly summary audit

26. ACTION PLANS Find the appropriate policies Maintain compliance with routine audits Ensure complete documentation Identify facility trends and present them at CQI

27. QUESTIONS