There are both short and long-stay Quality Measures (QM) for the use of Antipsychotics. Both measures impact Care Compare and the Five Star Quality Rating System.
The short-stay measure looks at the percentage of residents who newly received an antipsychotic medication during the target period, NOT on their initial assessment. The numerator for the short-stay measure is the number of Medicare Part A SNF stays for whom 1 or more assessments in a look-back scan indicate an antipsychotic medication was received. Again, this does not include the initial assessment. The denominator is the number of short stay residents, except those with exclusion, who meet all the following conditions,
· Have a target assessment, AND
· Have an initial assessment, AND
· Have a target assessment that is not the same as the initial assessment.
The long stay measure captures the percentage of residents who are receiving antipsychotic medications in the target period. The numerator for the long stay measure is all residents with a selected target assessment where it is true the resident has received antipsychotic medications – N0415A1 = 1. The denominator for this long stay measure is all residents with a selected target assessment, except those with exclusions.
For both measures, assessments are excluded if the resident has any of the following conditions present on any assessment in a look-back scan:
- N0415A1 = [ - ]
- Schizophrenia (I6000 = 1)
- Tourette’s syndrome (I5350 = 1)
- Huntington’s Disease (I5250 = 1)
There are no covariates for these measures. Also, for both measures, the lower the score the better the performance.
There are multiple areas reviewed by State Surveyors regarding the use of antipsychotics. These include the following Critical Element Pathways:
- Dementia Care
- Medication Regimen Review
- Psychotropic Medications
- Unnecessary Medications
These measures can be addressed in multiple ways by the Interdisciplinary Team and should be, particularly if your facility percentile is > 75. Utilize QAPI to address facility and resident level opportunities for improvement. For example, consult with the facility pharmacist to review reports and trends. Consider prioritization tools to foster antipsychotic medication reduction efforts.
QAPI opportunities at the resident level include meeting monthly with the pharmacist to review the individual’s medication list. Ensure active diagnoses are accurate based on physician assessment and involve the medical director in reviewing patient records and medications. During pre-admission, determine if the resident is on an antipsychotic and why. Limit PRN antipsychotic prescriptions to 14 days, then review and reorder as appropriate.
Further, discuss with resident, family members, and caregivers resident preferences, hobbies, likes, dislikes, and daily routines to minimize potential behaviors. Gather information and attempt non-pharmacological interventions and therapies. These may include various activities via the Activity Department. Referrals to occupational, physical, or speech therapy for individual and group interventions to address mobility, communication, and pain management to limit behaviors. Also, a move toward partnering with a group providing psychological counseling as well as pharmacological approaches may assist in limiting antipsychotic use.
There are also numerous resources available to develop strategies to approach antipsychotic medication reduction from the following:
· Alzheimer’s Association: Professionals – Alzheimer's & Dementia Care | Alzheimer's Association
· Great Plains Quality Improvement Organization: Resource Library | QIOProgram.org
· Comagine Health Quality Improvement Organization: Antipsychotic Medication Reduction Toolkit| Comagine Health
· CMS Quality Measures and User’s Manuals: Quality Measures | CMS
The overall goal for improvement with these quality measures is to limit antipsychotic use to those residents appropriately in need of such medications and to find alternative ways to address resident behaviors.