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Sa fe ly Re duc ing the Use o f Antipsyc ho tic Me dic a tio ns An Ove rvie w Sa ra h C. Sc huma nn Bro o kside Inn T he Qua lity I nitia tive Ame ric a n He a lthc a re Asso c ia tio n (AHCA) a nd CMS T riple Aim: 1. Be tte r He

  1. Sa fe ly Re duc ing the Use o f Antipsyc ho tic Me dic a tio ns An Ove rvie w Sa ra h C. Sc huma nn Bro o kside Inn

  2. T he Qua lity I nitia tive Ame ric a n He a lthc a re Asso c ia tio n (AHCA) a nd CMS T riple Aim: 1. Be tte r He a lth: Go o d fo r the Re side nts 2. Be tte r Qua lity: Go o d fo r the Nursing Ce nte r 3. Re duc e Co sts: Po ssib ly F uture I mpa c t

  3. Wha t is the I nitia tive ?  AHCA Qua lity I nitia tive Go a l: Sa fe ly re duc e the o ff-la b e l use o f a ntipsyc ho tic drug s b y 15% (3 ye a r initia tive sta rte d in 2012) CMS is to re duc e the o ff-la b e l use o f a ntipsyc ho tic me dic a tio n

  4. Antipsyc ho tic Me dic a tio ns:  Ola nza pine (Zypre xa ) •  • Aripipra zo le (Ab ilify)  • Rispe rido ne (Rispe rda l)  • Que tia pine (Se ro q ue l)  • Clo za pine (Clo za ril)  • Zipra sido ne (Ge o do n)  • Ha lo pe rido l (Ha ldo l)*  • T hio rida zine (Me lla ril)*  • Chlo rpo rma zine (T ho ra zine )*  • Pro c hlo rpe ra zine (Co mpa zine )*  • L o xa pine (L o xita ne )*  • Mo lindo ne (Mo b a n)  • T hio thixe ne (Na va ne )*  • Pimo zide (Ora p)*  • Me so rida zine (Se re ntil)  • F luphe na zine (Pro lixin)*  • T rifluo pe ra zine (Ste la zine )*  • Pro ma zine (Spa rine )*  • T riflupro ma zine (Ve sprin)*  • I lo pe rido ne (F a na pt)  • L ura sido ne (L a tuda )  • Pe rphe na zine (T rila fo n)*  • Clo za pine (F a za Clo )  • Pa lipe rido ne (I nve g a )   *F irst Ge ne ra tio n Antipsyc ho tic s; a ll o the rs wo uld b e c o nside re d “Se c o nd Ge ne ra tio n Antipsyc ho tic s”

  5. Wha t is CMS me a suring ?  Sho rt-Sta y I nc ide nc e % o f individua ls who ha ve a n a ntipsyc ho tic drug initia te d fo r a n o ff-la b e l use within the first 100 da ys o f a nursing fa c ility sta y E xc lusio ns: Antipsyc ho tic use ide ntifie d o n the initia l 1. a sse ssme nt - OR – Dia g no sis o f: Sc hizo phre nia , Hunting to n’ s 2. Dise a se o r T o ure tte ’ s Syndro me

  6. Wha t is CMS me a suring ?  L o ng -Sta y Pre va le nc e % o f lo ng -sta y re side nts with a n o ff-la b e l use o f a n a ntipsyc ho tic drug E xc lusio ns: Dia g no sis o f Sc hizo phre nia , Hunting to n’ s Dise a se o r T o ure tte ’ s Syndro me .

  7. Why re duc e o ff-la b e l use o f a ntipsyc ho tic me dic a tio n?  CMS e xpe c ta tio n  E xpe nse s re la te d to use o f a ntipsyc ho tic me dic a tio ns a nd inc re a se d pre va le nc e o f use  L a c k o f e ffic a c y  Qua lity o f L ife a nd Pe rso n-Ce nte re d Ca re

  8. CMS E ffo rts  CMS I nc re a se fo c us o n re vie wing use o f a ntipsyc ho tic drug s a nd pub lic ly re po rt use -On QI QMs, thus pa rt o f 5 sta r ra ting I nitia tive to re duc e use o f o ff-la b e l a ntipsyc ho tic me dic a tio ns -Ha nd in Ha nd T ra ining fo r Pe rso n-Ce nte re d Ca re -Surve yo r tra ining fo r c o mplia nc e

  9. CMS E ffo rts  CMS  Upda te d inte rpre tive g uide line s F 309, F 329  Pro vide d to o ls fo r surve y pro c e ss (QI S/ tra ditio na l)  Surve yo r tra ining pro g ra ms  L o c a l le a rning ne two rks with L ANE S a nd QI Os to disse mina te info rma tio n – Co lo rado Co alitio n to I mpro ve De me ntia Care in Nursing Ho me s

  10. E xpe nse s re la te d to Antipsyc ho tic Me dic a tio ns -E xpe nse o f a ntipsyc ho tic me dic a tio n sinc e 2000 -U.S sa le s (2000-2011) $5.4 b illio n - $12.6 b illio n -Pre sc riptio ns (‘ 00-’ 05) 29.9 millio n to 54 millio n -29% o f pre sc riptio ns dispe nse d b y L T C pha rma c ie s in 2011(~1 Rx pe r e ve ry L T C re side nt) -Me dic a id spe nds mo re mo ne y o n a ntipsyc ho tic s tha n it do e s o n a ntib io tic s o r he a rt me dic a tio ns -40 ne w a ntipsyc ho tic drug s in de ve lo pme nt G. Alle n Po we r, M.D.

  11. Risks re la te d to a ntipsyc ho tic me dic a tio ns Risks o f a ntipsyc ho tic drug use  Se da tio n, le tha rg y  Ga it disturb a nc e , fa lls  Rig idity a nd o the r mo ve me nt diso rde rs  Co nstipa tio n, po o r inta ke  We ig ht g a in  E le va te d b lo o d sug a r  I nc re a se risk o f pne umo nia  I nc re a se d risk o f stro ke Ba lla rd e t a l. (2009): Do ub le mo rta lity ra te (a t le a st18 studie s no w sho w inc re a se d mo rta lity)

  12. Ho w do nursing ho me s a c c o mplish re duc tio n?  Sta ff re te ntio n a nd Co nsiste nt Assig nme nt  T ra c king Syste ms  Co lla b o ra tio n  E duc a tio n  Alte rna tive inte rve ntio ns

  13. Sta ff Re te ntio n a nd Co nsiste nt Assig nme nt  T he sa me sta ff c a ring fo r the sa me re side nts will de ve lo p re la tio nships  E duc a tio na l e ffo rts a re mo re suc c e ssful

  14. T ra c king Syste ms  L T C T re nd T ra c ke r thro ug h AHCA o r Adva nc ing E xc e lle nc e tra c king fo rms  Da ily T e le pho ne Orde r re vie w  L ist fro m pha rma c y with re side nts o n a ntipsyc ho tic me dic a tio ns with dia g no sis  Psyc ho tro pic Me dic a tio n c o mmitte e  Cha mpio n in b uilding – a ll ne w o rde rs fo r a ntipsyc ho tic me dic a tio ns g o thro ug h the m  Bring da ta o f a ntipsyc ho tic use to QA&A me e ting

  15. Co lla b o ra tio n  Wo rk with pe e rs in L T C c o mmunity  Sha re b e st pra c tic e  AHCA, CHCA, CF MC (Co lo ra do ’ s QI O)  CMS, CDHCPF , CDPHE , Omb udsme n  Co lo ra do Co a litio n to I mpro ve De me ntia Ca re in Nursing Ho me s  Alzhe ime r’ s Asso c ia tio n  Pio ne e r Ne two rk

  16. E duc a tio n  T ra ining  Administra tio n  Physic ia ns  Sta ff (c linic a l a nd no n-c linic a l)  Re side nt/ F a mily/ Re spo nsib le Pa rty  T ra ining o n pro viding c a re fo r individua ls with de me ntia  Ha nd in Ha nd CMS T ra ining mo dule

  17. Alte rna tive a nd No n- pha rma c o lo g ic a l I nte rve ntio ns  E nviro nme nt (so und le ve ls, te mpe ra ture s)  Pro pe r Asse ssme nt (is the issue o ne o f vo iding , pa in, thirst? I s the re a me dic a l issue suc h a s infe c tio n? )  Aro ma the ra py  E xe rc ise  T o uc h the ra pie s  Alte rna tive he a ling mo da litie s

  18. Cha lle ng e s with I nitia tive  Nursing Ho me s a re c urre ntly the o nly pro vide r ma nda te d to re duc e the o ff- la b e l use o f a nti-psyc ho tic me dic a tio ns  -Admissio ns fro m ho spita ls, ho me s  -Physic ia ns write the o rde rs, nursing ho me s c ha lle ng e d to find pro vide rs  No a dditio na l funding fo r c o mplia nc e

  19. Cha lle ng e s with I nitia tive  Gra dua l Do se Re duc tio n a re no t c a pture d  Ne wly a dmitte d re side nts using a ntipsyc ho tic s  F a mily e duc a tio n a nd fe a rs  Clo sure o f inpa tie nt g e ro psyc h fa c ility in De nve r

  20. Co lo ra do Re sults  We a re impro ving  Gra phs re pre se nt info rma tio n fro m Q12011 thro ug h Q42012

  21. Regional Summary for Facility Antipsychotic Quality Measures Average percentage Average percentage of Number of Average Percent of of long-stay residents short-stay residents Number of surveys with number of Region surveys with receiving an newly receiving an surveys Tag 329 residents in Tag 329 cited antipsychotic antipsychotic cited facility medication medication 01 960 128 13.3 95.0 25.4 2.4 02 1003 139 13.9 152.4 19.9 2.7 03 1411 285 20.2 105.7 21.6 2.9 04 2684 312 11.6 94.4 25.1 3.4 05 3439 861 25.0 83.4 22.4 2.5 06 2093 233 11.1 77.7 28.1 4.0 07 1516 347 22.9 62.0 23.7 3.0 08 630 174 27.6 64.6 21.3 2.3 09 1476 363 24.6 82.9 20.2 2.5 10 457 164 35.9 64.1 21.8 2.1

  23. Mo st Curre nt I nfo rma tio n  Off-la b e l a ntipsyc ho tic use re le a se d Oc to b e r 2013 fo r Q12013  Na tio na l Ave ra g e 21.71%  Re g io n 8 18.92%  Co lo ra do 18.5%  Co lo ra do ra nke d 13 th lo we st use in na tio n

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