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By Ashley Gay, PharmD – Gayco Consultant Pharmacist

There seems to be an overall upward trend in psychoactive numbers in many skilled nursing and assisted living facilities since the beginning of COVID. I think this is to be expected given the mental toll this virus has taken on our elderly residents. I wouldn’t be surprised if we see an increased focus on Unnecessary Medication tags as annual state surveys resume.

Make sure the following are in place for residents with psychoactive meds:

  1. Appropriate diagnosis. Avoid vague diagnoses for antipsychotics such as anxiety, agitation, or insomnia. Appropriate diagnosis for antipsychotics includes dementia with agitation, psychosis, Schizophrenia, Bipolar disorder, etc……
  2. Non-Pharmacological approaches must be attempted and documented instead of using psychotropic medications, along with the use of psychotropic medications, and while a GDR is attempted
  3. Behavior and Side Effect Monitoring every shift
  4. PRN Psychotropic Orders (that are not antipsychotics) are limited to 14 days and may be extended by the prescriber. Remember to include the stop date in the directions of the order.
  5. PRN Antipsychotics are limited to 14 days. They cannot be renewed unless the prescriber evaluates the resident to determine if it is appropriate to write a new PRN Order. The evaluation must be in-house and include documentation of continued need, the benefit of medication to the resident, and whether indications of resident distress have improved as a result of the medication.
  6. Gradual Dose Reduction Requests. Your consultant pharmacist will request dose reductions as required by CMS Guidelines. Please remind prescribers to document clinical rationale when declining our recommendations. Failure to do so may result in a citation. The regulations for dose reductions and stop dates for PRN psychotropic orders do not exclude hospice residents.

Please feel free to contact us if you have any specific resident concerns such as falls or adverse drug events throughout the month. We are here to help you.