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Is Antipsychotic Medication Reduction Making You Crazy?

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The Centers for Medicare and Medicaid Services (CMS) recently released S&C Memo 13-35-NH, which discusses the use of psychopharmacological medications and behavioral management in America’s Nursing …

The Centers for Medicare and Medicaid Services (CMS) recently released S&C Memo 13-35-NH, which discusses the use of psychopharmacological medications and behavioral management in America’s Nursing Homes. The management of behavioral or psychological symptoms of dementia (BPSD) is a challenge in Nursing Homes. In this presentation viewers will learn valuable behavioral management techniques that can be utilized to decrease patient dependency on psychopharmacological medication. Important government initiatives, including The Partnership to Improve Dementia Care in Nursing Homes are discussed. The presentation also discusses the recent updates to interpretive guidelines of F309 (Quality of Care) and F329 (Unnecessary Drugs), and details the Seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD.

1. Learn the content of S&C Memo 13-35-NH and the implications of this memo on daily resident care

2. Learn to articulate the intent and impact of F309 and F329 on resident health and well-being, and identify strategies to maintain compliance with the regulatory intent of these regulations

3. Learn about the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD

4. Identify the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD


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  • 1. Is Antipsychotic Medication Reduction Making You Crazy? HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Kim Steele RN, WCC, RAC-CT, CHHRP Regional Consultant and Trainer
  • 2. Speaker Bio Regional Consultant and Trainer for Harmony Healthcare International, Inc. Over 28 years experience in Long-term Care and Cardiac CCU Shift Supervisor MDS and Care Plan Coordinator for 5 years Director of Nursing for 18 years Trained staff in IV-Certification, MDS 2.0, MDS 3.0, PPS, ADLs and Regulatory Compliance, Infection Control and OSHA Specialty in Wound Care and Survey Compliance for both Standard and QIS Surveys Provides education in all aspects of Therapy and Nursing Medicare Documentation Requirements, completing CAAs and Care Plan Development, Wound Assessment and Documentation Expert in NY State Medicaid/CMI Reimbursement and Documentation and training for Successfully Preparing for the NY State OMIG Audit Copyright © 2013 All Rights Reserved 2Harmony Healthcare International, Inc.
  • 3. Is Antipsychotic Medication reduction Making You Crazy? Disclosures: The planners and presenters of this educational activity have no relationship with commercial entities or conflicts of interest to disclose Planners: Elisa Bovee, MS, OTR/L Diane Buckley, BSN, RN, RAC-CT Beckie Dow, RN, RAC-MT Keri Hart, MS CCC, SLP, RAC-CT Kristen Mastrangelo, OTR/L, MBA, NHA Christine Twombly, RNC, RAC-MT, LHRM Presenter: Kim Steele, RN, WCC, RAC-CT, CHHRP Copyright © 2013 All Rights Reserved 3Harmony Healthcare International, Inc.
  • 4. Is Antipsychotic Medication reduction Making You Crazy? Disclosure Speaker: Kim Steele, RN, WCC, RAC-CT, CHHRP Regional Consultant and Trainer The speaker has no relevant financial relationships to disclose The speaker has no relevant nonfinancial relationships to disclose Copyright © 2013 All Rights Reserved 4Harmony Healthcare International, Inc.
  • 5. Program Objectives The learner will be able to discuss the content of S&C Memo 13-35-NH The learner will be able to articulate the impact of F309 and F329 on resident health and well-being The learner will be able to list three risks of antipsychotic use for the elderly The learner will be able to identify the seven Dementia Care Principles The learner will be able to list three non- pharmacological interventions for behavior management Copyright © 2013 All Rights Reserved 5Harmony Healthcare International, Inc.
  • 6. Is Antipsychotic Medication Reduction Making You Crazy? Copyright © 2013 All Rights Reserved 6Harmony Healthcare International, Inc.
  • 7. S&C Memo 13-35-NH Released May 24, 2013 Conveys clarification to Appendices P and PP related to nursing home residents and F309 (Quality of Care) and F329 (Unnecessary Drugs) Announces mandatory surveyor trainings, which are available online at http://surveyortraining.cms.hhs.gov Copyright © 2013 All Rights Reserved 7Harmony Healthcare International, Inc.
  • 8. F309-Quality of Care (§483.25) Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care Copyright © 2013 All Rights Reserved 8Harmony Healthcare International, Inc.
  • 9. F309-Quality of Care (§483.25) Intent: The facility must ensure that the resident obtains optimal improvement or does not deteriorate within the limits of a resident’s right to refuse treatment, and within the limits of recognized pathology and the normal aging process Copyright © 2013 All Rights Reserved 9Harmony Healthcare International, Inc.
  • 10. F329-Unnecessary Drugs (§483.25) Antipsychotic Drugs—Based on a comprehensive assessment of the resident, the facility must ensure that (i)Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the medical record; and Copyright © 2013 All Rights Reserved 10Harmony Healthcare International, Inc.
  • 11. F329-Unnecessary Drugs (§483.25) Antipsychotic drugs, (continued) (ii)Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs Copyright © 2013 All Rights Reserved 11Harmony Healthcare International, Inc.
  • 12. F329-Unnecessary Drugs (§483.25) Intent: Each resident’s entire drug/medication regimen be managed and monitored to reach the following goals: The medication regimen helps promote or maintain the resident’s highest practicable mental, physical, and psychosocial well-being, as identified by the resident and/or representative(s) in collaboration with the attending physician and facility staff; Copyright © 2013 All Rights Reserved 12Harmony Healthcare International, Inc.
  • 13. F329-Unnecessary Drugs (§483.25) Intent (Continued) Each resident receives only those medications, in doses and for the duration clinically indicated to treat the resident’s assessed condition(s); Non-pharmacological interventions (such as behavioral interventions) are considered and used when indicated, instead of, or in addition to, medication; Copyright © 2013 All Rights Reserved 13Harmony Healthcare International, Inc.
  • 14. F329-Unnecessary Drugs (§483.25) Intent (Continued) Clinically significant adverse consequences are minimized; and The potential contribution of the medication regimen to an unanticipated decline or newly emerging or worsening symptom is recognized and evaluated, and the regimen is modified when appropriate Copyright © 2013 All Rights Reserved 14Harmony Healthcare International, Inc.
  • 15. Partnership to Improve Dementia Care in Nursing Homes Launched March 29, 2012 (formerly known as National Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Drug Use in Nursing Homes) The goal of this partnership is to “optimize the quality of life and function of residents in America’s nursing homes by improving approaches to meet the health, psychosocial and behavioral health needs of all residents, especially those with dementia” Copyright © 2013 All Rights Reserved 15Harmony Healthcare International, Inc.
  • 16. Partnership to Improve Dementia Care in Nursing Homes Per CMS, “Individualized, person- centered approaches may help reduce potentially distressing or harmful behaviors and promote improved functional abilities and quality of life for residents” Copyright © 2013 All Rights Reserved 16Harmony Healthcare International, Inc.
  • 17. Partnership to Improve Dementia Care in Nursing Homes The CMS has joined with various stakeholders to improve care in nursing homes Actions: Surveyor training videos Updated Appendix P Updated Appendix PP Copyright © 2013 All Rights Reserved 17Harmony Healthcare International, Inc.
  • 18. Partnership to Improve Dementia Care in Nursing Homes Three Surveyor Training Videos: http://surveyortraining.cms.hhs.gov Overview of dementia care and potential approaches to addressing behavioral distress Walks surveyors thorough portions of an annual survey and focuses on the evaluation of a patient with dementia Revised interpretive guidance for F309 and F329 and how to determine severity for non-compliance related to care of a patient with dementia (still under development) Copyright © 2013 All Rights Reserved 18Harmony Healthcare International, Inc.
  • 19. Partnership to Improve Dementia Care in Nursing Homes Updates to Appendix P: Changes to the resident sampling process for the traditional survey Changes to QIS were included in the recent 10.1.3 release This change is intended to ensure that the survey sample includes an adequate number or residents with dementia who are receiving antipsychotic medication Copyright © 2013 All Rights Reserved 19Harmony Healthcare International, Inc.
  • 20. Partnership to Improve Dementia Care in Nursing Homes Updates to Appendix PP: A new section of interpretive guidance at F309 related to the review of care and services for a resident with dementia Revisions to the antipsychotic medication section of Table 1 at F329 New severity example at he end of the interpretive guidance at F329 Copyright © 2013 All Rights Reserved 20Harmony Healthcare International, Inc.
  • 21. Partnership to Improve Dementia Care in Nursing Homes A checklist was created for surveyor use This checklist can be used in either traditional or QIS survey The checklist is not part of the SOM, but was included in 13-35-NH for providers review Copyright © 2013 All Rights Reserved 21Harmony Healthcare International, Inc.
  • 22. The Concern… In the past, psychopharmacological medications have been used without first determining whether there is a medical, physical, functional, psychological, emotional, psychiatric, social or environmental cause of the behaviors Medication may be effective when they are used appropriately to address significant, specific underlying medical of psychiatric causes, or new or worsening behavioral symptoms Copyright © 2013 All Rights Reserved 22Harmony Healthcare International, Inc.
  • 23. The Concern… Medications may be ineffective and are likely to cause harm if given without a clinical indication All interventions, including medications, need to be monitored for efficacy, risks, benefits and harm CMS states that its concern is that NHs may use medication as a “quick fix” for behavioral health issues and concerns Copyright © 2013 All Rights Reserved 23Harmony Healthcare International, Inc.
  • 24. The Risk… Antipsychotic medication is frequently prescribed for residents who have behavioral or psychological symptoms of dementia (BPSD) The term BPSD is used to describe behavior or other symptoms in individuals with dementia that cannot be attributed to a specific medical or psychiatric cause Copyright © 2013 All Rights Reserved 24Harmony Healthcare International, Inc.
  • 25. The Risk… When antipsychotic medications are used without an adequate rationale, or for the purpose of limiting or controlling behavior of an unidentified cause, there is little change that they will be effective These medications commonly cause complications such as movement disorders, falls, hip fractures, CVAs, TIAs, and increased risk of death Copyright © 2013 All Rights Reserved 25Harmony Healthcare International, Inc.
  • 26. The Risk… The Food & Drug Administration (FDA) Black Box Warning Regarding Atypical Antipsychotics in Dementia reads: “Elderly patients with dementia- related psychosis treated with atypical antipsychotic drugs are at an increased risk for death compared to placebo” Copyright © 2013 All Rights Reserved 26Harmony Healthcare International, Inc.
  • 27. Resident’s Rights… Informed Decision-Making: Residents have the right to be informed about the risks and benefits of any medication Right to Refuse: Residents have the right to refuse any medication Freedom from Chemical Restraints: It is against the law to give medications that do not benefit the resident, such as for convenience of staff Copyright © 2013 All Rights Reserved 27Harmony Healthcare International, Inc.
  • 28. Dementia Care Principles Fundamental principles of care for a resident with dementia include an interdisciplinary approach that focuses on the needs of the resident as well as the needs of other residents in the nursing home The revised CMS guidance and surveyor training highlight and re- emphasize these principles Copyright © 2013 All Rights Reserved 28Harmony Healthcare International, Inc.
  • 29. Dementia Care Principles 1. Person-Centered Care CMS requires nursing homes to provide a supportive environment that promotes comfort and recognizes individual needs and preferences Copyright © 2013 All Rights Reserved 29Harmony Healthcare International, Inc.
  • 30. Dementia Care Principles 2. Quality and Quantity of Staff The nursing home must provide staff, both in terms of quantity (direct care as well as supervisory staff) and quality to meet the needs of the residents as determined by resident assessments and individual plans of care Copyright © 2013 All Rights Reserved 30Harmony Healthcare International, Inc.
  • 31. Dementia Care Principles 3. Thorough Evaluation of New or Worsening Behaviors Residents who exhibit new or worsening symptoms should have an evaluation by the interdisciplinary team, including the physician, in order to identify and address treatable medical, physical, emotional, psychiatric, psychological, functional, social, and environmental factors that may be contributing to behaviors Copyright © 2013 All Rights Reserved 31Harmony Healthcare International, Inc.
  • 32. Dementia Care Principles 4. Individualized Approaches to Care Utilizing a consistent process that focuses on a resident’s individual needs and tries to understand behavior as a form of communication may help to reduce behavioral expressions of distress in some residents Individualized approaches are the first line intervention for BPSD in the US, UK, and Canada Copyright © 2013 All Rights Reserved 32Harmony Healthcare International, Inc.
  • 33. Dementia Care Principles 5. Critical Thinking Related to Antipsychotic Drug Use Some residents will benefit from the use of antipsychotic medication The resident should only be given the medication if clinically indicated and as necessary to treat a specific condition and target symptoms as diagnosed and documented in the medical record Copyright © 2013 All Rights Reserved 33Harmony Healthcare International, Inc.
  • 34. Dementia Care Principles 5. Critical Thinking Related to Antipsychotic Drug Use Residents who use antipsychotic drugs must receive gradual dose reductions and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs Surveyors are instructed to review F222 (Right to be Free from Chemical Restraints) Copyright © 2013 All Rights Reserved 34Harmony Healthcare International, Inc.
  • 35. Dementia Care Principles 6. Interviews with Prescribers Surveyors are instructed to evaluate the process of care, not evaluate the practice of medicine Surveyors interview the attending physician or other primary care provider (NP, PA), behavioral health specialist, pharmacist, and other team members to better understand the reasons for using a psychopharmacological agent or any other intervention for a specific resident Copyright © 2013 All Rights Reserved 35Harmony Healthcare International, Inc.
  • 36. Dementia Care Principles 7. Engagement of Resident and/or Representative in Decision-Making Residents (to the extent possible) and/or family or resident representatives must be involved in the discussion of potential approaches to address behavioral symptoms These discussions with the resident and/or family or representative should be documented in the medical record Copyright © 2013 All Rights Reserved 36Harmony Healthcare International, Inc.
  • 37. Antipsychotic Meds and Quality Measures Copyright © 2013 All Rights Reserved 37Harmony Healthcare International, Inc.
  • 38. Antipsychotic Meds and Quality Measures Antipsychotic med use affects two Quality Measures One long-stay and one-short stay Percent of Residents Who Newly Received an Antipsychotic Medication (short) Percent of Residents Who Received an Antipsychotic Medication (long) Copyright © 2013 All Rights Reserved 38Harmony Healthcare International, Inc.
  • 39. Purpose of the Quality Measures According to the CMS, Quality Measures (QMs) have four purposes for consumers: To give you information about the quality of care at nursing homes in order to help you choose a nursing home for yourself or others; To give you information about the care at nursing homes where you or your family members already live; Copyright © 2013 All Rights Reserved 39Harmony Healthcare International, Inc.
  • 40. Purpose of the Quality Measures According to the CMS, Quality Measures (QMs) have four purposes for consumers (Continued): To give you information to facilitate your discussions with the nursing home staff regarding the quality of care; and To give data to the nursing home to help them in their quality improvement efforts Copyright © 2013 All Rights Reserved 40Harmony Healthcare International, Inc.
  • 41. Quality Measures: The Basic Calculation QMs begin as a simple fraction (or ratio): Numerator: all residents that trigger Denominator: all residents of the facility minus exclusions Risk adjustment then refines raw QM scores to better reflect the status of residents in the facility Most measures use at least one exclusion The prevalence of an outcome after exclusions is the facility-level observed score Copyright © 2013 All Rights Reserved 41Harmony Healthcare International, Inc.
  • 42. Percent of Residents Who Newly Received an Antipsychotic Medication (Short-Stay) Numerator: Short-stay residents for whom one or more assessments in a look-back scan indicates antipsychotic medication was received Denominator: All short-stay residents who do not have exclusions and who meet all of the following conditions: Has a target assessment Has a initial assessment Target and initial assessment are not the same assessment Copyright © 2013 All Rights Reserved 42Harmony Healthcare International, Inc.
  • 43. Percent of Residents Who Newly Received an Antipsychotic Medication (Short-Stay) Exclusions: Incomplete / missing data Diagnosis coded on the MDS: Schizophrenia Tourette’s Syndrome Huntington’s Disease Copyright © 2013 All Rights Reserved 43Harmony Healthcare International, Inc.
  • 44. Percent of Residents Who Newly Received an Antipsychotic Medication (Short-Stay) Clinical Considerations: Non-pharmacological approaches to behavior management and appropriate GDRs Antipsychotic medications carry a number of risks for use in the elderly Individualized behavior plans Pharmacy reviews and Psych evaluations Assess cognition and “play up” strengths Copyright © 2013 All Rights Reserved 44Harmony Healthcare International, Inc.
  • 45. Percent of Residents Who Received an Antipsychotic Medication (Long-Stay) Numerator: Long-stay residents with a target assessment that indicates an antipsychotic medication was received Denominator: All long-stay residents who do not have exclusions Copyright © 2013 All Rights Reserved 45Harmony Healthcare International, Inc.
  • 46. Percent of Residents Who Received an Antipsychotic Medication (Long-Stay) Exclusions: Incomplete / missing data Any of the following diagnoses coded on the MDS: Schizophrenia Tourette’s Syndrome Huntington’s Disease Copyright © 2013 All Rights Reserved 46Harmony Healthcare International, Inc.
  • 47. Percent of Residents Who Received an Antipsychotic Medication (Long-Stay) Clinical Considerations: Non-pharmacological approaches to behavior management and appropriate GDRs Antipsychotic medications carry a number of risks for use in the elderly Individualized behavior plans Pharmacy reviews and Psych evaluations Assess cognition and “play up” strengths Copyright © 2013 All Rights Reserved 47Harmony Healthcare International, Inc.
  • 48. Percent of Residents Who Received an Antipsychotic Medication (Long-Stay) Clinical Considerations Use of antipsychotics should be at t he recommendation of the Interdisciplinary Team, a Mental Health Professional or MD All patients who receive an antipsychotic should have routine screening for extra pyramidal effects. This screen should be initiated within 72 hours of starting edication to establish a baseline. Copyright © 2013 All Rights Reserved 48Harmony Healthcare International, Inc.
  • 49. Percent of Residents Who Received an Antipsychotic Medication (Long-Stay) Clinical Considerations Notify the appropriate medical personnel of any changes When the Interdisciplinary Team feels it would be inappropriate from a clinical standpoint to attempt a GDR, consider completing a risk vs. benefit analysis that the team, MD and patient or family reviews and signs Copyright © 2013 All Rights Reserved 49Harmony Healthcare International, Inc.
  • 50. Documentation Requirements Determine appropriateness of a Gradual Dose Reduction (GDR) and document that decision in detail. Current regulation requires ongoing monitoring for adverse consequence and GDR when clinically appropriate. Patients receiving any psychoactive medication must have the positive effect and/or potential adverse consequence monitored routinely by the Interdisciplinary Team Copyright © 2013 All Rights Reserved 50Harmony Healthcare International, Inc.
  • 51. Documentation Requirements This monitoring should be documented and reviewed by the attending MD on a regular basis who will then make a decision regarding the clinical appropriateness of a GDR and document that decision in detail Ensure that the Pharmacy Consultant is involved in this process and makes recommendations as indicated Copyright © 2013 All Rights Reserved 51Harmony Healthcare International, Inc.
  • 52. Monitoring Clinically appropriate Time frames All disciplines responsible Expected by DOH Rationale for monitoring Best way to track adverse consequence Assists with clinical support for attempting or not attempting GDR Assist with care planning Copyright © 2013 All Rights Reserved 52Harmony Healthcare International, Inc.
  • 53. Monitoring Multiple tools available AIMS Facial and oral movements Extremity movement Global judgment Dental Status EPSE –Extra Pyramidal Side Effect Tool Copyright © 2013 All Rights Reserved 53Harmony Healthcare International, Inc.
  • 54. Monitoring Facility specific tool – things to consider Tremors Blink rate Weight fluctuation Change in sleep pattern Change in behaviors Copyright © 2013 All Rights Reserved 54Harmony Healthcare International, Inc.
  • 55. Developing the Plan of Care Develop non-medication interventions from all disciplines Be creative in developing new interventions if some don’t work Some conditions will require immediate medication intervention When the Team determines it is clinically appropriate to do so, medication therapy will be initiated Copyright © 2013 All Rights Reserved 55Harmony Healthcare International, Inc.
  • 56. Developing the Plan of Care KEY POINT: The use of any psychoactive medication will require the Care Plan Team to develop a detailed and patient specific care plan addressing the behavioral symptom that the medication is being given for Copyright © 2013 All Rights Reserved 56Harmony Healthcare International, Inc.
  • 57. Developing the Care Plan Some patients will continue to have behaviors that are not relieved with non-pharmacological interventions Once the decision to use antipsychotic medication is made it is critical to address the use of the antipsychotic medication in the existing care plan Include how the patient will be monitored for both positive effects and adverse consequences Copyright © 2013 All Rights Reserved 57Harmony Healthcare International, Inc.
  • 58. 12 Questions to Consider During Interdisciplinary Team Review Copyright © 2013 All Rights Reserved 58Harmony Healthcare International, Inc.
  • 59. Question 1 If the behavioral symptoms represent a change or worsening, was a medical work-up performed to rule out underlying medical or physical causes of the behaviors, if appropriate? Copyright © 2013 All Rights Reserved 59Harmony Healthcare International, Inc.
  • 60. Question 2 Were current medications considered as potential causes of the behaviors (i.e., those with significant anticholinergic or other side effects?) Copyright © 2013 All Rights Reserved 60Harmony Healthcare International, Inc.
  • 61. Question 3 If a medical cause (e.g., UTI) was identified, was treatment (if indicated) initiated in a timely manner? Copyright © 2013 All Rights Reserved 61Harmony Healthcare International, Inc.
  • 62. Question 4 If medical causes were ruled out, did the staff attempt to establish the root causes of the behaviors, using a careful and systematic process and individualized knowledge about the resident when possible? Were family caregivers or others who knew the resident prior to his/her dementia consulted about prior life patterns, responses to stress, etc? Copyright © 2013 All Rights Reserved 62Harmony Healthcare International, Inc.
  • 63. Question 5 Was the clinical indication for the medication valid? Copyright © 2013 All Rights Reserved 63Harmony Healthcare International, Inc.
  • 64. Question 6 Were non-pharmacologic, person- centered intervention tried before medications (other than emergency)? Were the results documented? Copyright © 2013 All Rights Reserved 64Harmony Healthcare International, Inc.
  • 65. Question 7 Were specific target behaviors identified and desired outcomes related to those behaviors documented? Were caregivers aware of the target behaviors and desired results of the medication? Copyright © 2013 All Rights Reserved 65Harmony Healthcare International, Inc.
  • 66. Question 8 Was the resident or appropriate legal representative consulted about the decision to use an antipsychotic medication and was that discussion documented? Copyright © 2013 All Rights Reserved 66Harmony Healthcare International, Inc.
  • 67. Question 9 If the drug is continued for more than a few weeks, is the original clinical indication still valid (are the behaviors still present)? Copyright © 2013 All Rights Reserved 67Harmony Healthcare International, Inc.
  • 68. Question 10 Is appropriate monitoring in place and is the team aware of the potential side effects? Copyright © 2013 All Rights Reserved 68Harmony Healthcare International, Inc.
  • 69. Question 11 If new symptoms or changes in condition occurred after an antipsychotic medication was started, was medication use considered as a potential cause of a change or symptom? Copyright © 2013 All Rights Reserved 69Harmony Healthcare International, Inc.
  • 70. Question 12 If on a medication, did the pharmacist perform a medication regimen review and identify related signs and symptoms, or did the staff inform the pharmacist if symptoms occurred after the last pharmacist visit? Copyright © 2013 All Rights Reserved 70Harmony Healthcare International, Inc.
  • 71. Provider Self-Assessment Tool Appropriate dementia care includes more than managing individuals with dementia-related behavior Facilities must manage various factors while also optimizing function in medically complex patients Facility systems are key in antipsychotic medication management Copyright © 2013 All Rights Reserved 71Harmony Healthcare International, Inc.
  • 72. Provider Self-Assessment Tool Copyright © 2013 All Rights Reserved 72Harmony Healthcare International, Inc.
  • 73. Provider Self-Assessment Tool See handouts: Partnership to Improve Dementia Care in Nursing Homes State Coalition Provider Question Worksheet (Self-Assessment Tool) Partnership to Improve Dementia Care in Nursing Homes Provider Implementation Flow Diagram Copyright © 2013 All Rights Reserved 73Harmony Healthcare International, Inc.
  • 74. Provider Self-Assessment Tool Explore staff’s reaction to behavioral responses by persons with dementia in your facility Determine if residents and families given information about care options for persons with dementia, including those that do or do not use medications Copyright © 2013 All Rights Reserved 74Harmony Healthcare International, Inc.
  • 75. Provider Self-Assessment Tool How will your facility measure success in improving dementia care and reducing or optimizing antipsychotic drug use? Involve medical director, pharmacist Staff education about behavior management and facility policy and procedure for behavior management Copyright © 2013 All Rights Reserved 75Harmony Healthcare International, Inc.
  • 76. Section S (State Specific) Section S is an optional section of the MDS 3.0 assessment Each state can choose if they wish to include Section S Each state can also determine what items they wish to include in Section S Massachusetts recently added antipsychotic reduction questions Copyright © 2013 All Rights Reserved 76Harmony Healthcare International, Inc.
  • 77. Section S (state specific) Massachusetts Section S: Determines if the resident has received and antipsychotic Determines if a dose reduction was done Determines if the dose reduction was maintained Determines if non-pharmacological resident centered care techniques were utilized Copyright © 2013 All Rights Reserved 77Harmony Healthcare International, Inc.
  • 78. Final Thoughts Unnecessary use of antipsychotic medications can have serious side effects for the elderly population Individualized, person-centered approach to manage behavioral symptoms is key Holistic, interdisciplinary approach to behavioral symptom management Copyright © 2013 All Rights Reserved 78Harmony Healthcare International, Inc.
  • 79. References Survey & Certification Memo 13-35-NH http://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertificationGenInfo/Policy-and-Memos-to- States-and-Regions-Items/Survey-and-Cert-Letter-13-35.html Quality Measures Users Manual http://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment- Instruments/NursingHomeQualityInits/NHQIQualityMeasures. html Copyright © 2013 All Rights Reserved 79Harmony Healthcare International, Inc.
  • 80. References Advancing Excellence in America’s Nursing Homes http://www.nhqualitycampaign.org/star_index.aspx?controls=d ementiaCare Circular letter DHCQ 13-9-597 (state of Massachusetts) Copyright © 2013 All Rights Reserved 80Harmony Healthcare International, Inc.
  • 81. Questions/Answers Harmony Healthcare International 1 (800) 530 – 4413 KSteele@harmony-healthcare.com www.harmony-healthcare.com Harmony Healthcare International, Inc. 81Copyright © 2013 All Rights Reserved 81Harmony Healthcare International, Inc.
  • 82. Harmony Healthcare International Have you Considered a Customized Complimentary HARMONY(HHI) MEDICARE PROGRAM EVALUATION or CASE MIX ANALYSIS for your Facility? Perhaps your facility has potential for additional revenue Assess your facility against key indicators and national norms Email us at for more information RUGS@harmony-healthcare.com Analysis is cost & obligation free Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved 82Harmony Healthcare International, Inc.