Med Director Report: Psychotropics and Deprescribing

 Med Dir Report 11-2022 here

Choosing Wisely - 15 things we should question

Phase 3 guidance: GDR regulations 

·       Non-traditional meds such as antihistamines, seizure meds, other CNS meds, when use appears to be a substitute for a traditional psychotropic are now subject to GDR guidelines

·       Attempt GDR: Twice within the first year, in two separate quarters, at least one month apart.  After the first year, reductions must be attempted annually

·       GDRs should be done in a manner than minimizes withdrawal with appropriate tapers.

o   Dose changes may take 4-6 weeks to see full effect.  Be careful not to classify a failure 3 days into an attempted GDR.

·       CMS surveyors will look for the potential of psychosocial harm by interviewing staff and/or resident to determine if side effects have adversely affected the resident’s QOL

o   Renewal requires a new prescription AND a direct evaluation of the patient by the prescriber

o   Prescriber must document a specific rationale for therapy, specific benefits to patient, and progress to goals of therapy.

·       Antipsychotics –absolute hard stop on PRN antipsychotics at 14 days.  No exceptions.

·       Other psychotropics – limited to 14 days unless:

o   Prescriber documents specific diagnosis, treatment benefits, rationale for extending beyond 14 days AND a specific duration of treatment

o   includes antihistamines such as hydroxyzine when uses for behaviors

·       Compazine is an antipsychotic

·       Hospice is NOT EXEMPT from PRN rules or any rules.

·       Documentation should include an indication with an identified clinical rationale that is based upon an assessment of the resident’s condition and therapeutic goals