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Antipsychotics

Target: By December 2, 2013 at 12:00 p.m., safely reduce off-label use of antipsychotics by 15 percent.  Communities that have less than 5 percent of off-label use maintain rates at or below 5 percent.  All communities will implement use of at least one tool aimed at reducing off-label use of antipsychotics by December 2013.   

A large number of the individuals in assisted living communities are living with some type of dementia. For these individuals, behavior often becomes one of the few remaining forms of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior. This use is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia.

Antipsychotic drugs are expensive, costing hundreds of millions of Medicare dollars. They also increase the risk of falls with fractures, hospitalizations, and other complications resulting in poor health and high costs

How can assisted living communities achieve this goal? 

Facilities can focus on non-pharmacologic approaches for preventing the frustrations that can lead to challenging behavior and for addressing resident’s behavioral expressions when they do occur. One of these approaches is consistent staff assignment. 
  • If a person knows their caregiver, and the caregiver knows the best ways to communicate with the individual - their routines and preferences, likes and dislikes - then it’s less likely that a negative behavioral response will be triggered.
  • How staff interacts with residents is also important. Using a positive physical approach, engaging residents in meaningful activity, and using therapeutic strategies for catastrophic events can make a real difference for residents with dementia.
  • Examine the tools on this website and select at least one tool to implement in your community. 
  • Assisted living communities can also focus on environmental changes that can contribute to a more positive atmosphere and make it less likely to confuse or frustrate residents. For example, reducing noise, improving lighting, and allowing flexible scheduling.
 

 Documents

 
 

 Resources

 

Antipsychotic Consumer Fact Sheet

The consumer fact sheet provides family members and others involved in a resident’s care background on the off-label use of antipsychotics, as well as frequently asked questions regarding loved ones living with dementia. It also gives family members suggestions on how they can partner with providers to get the best possible care for their loved one.

Download:

 

The Antipsychotic Drug SBAR (Members Only Content)

The Antipsychotic Drug SBAR is a tool for clinical staff to use to gather and organize the information needed in preparation for physician discussion about potential tapering for antipsychotic drug off-label use. Completed SBARs offer a method to document nurse/physician communication and recommendations and are a component of the individual’s medical record.


Improving Antipsychotic Appropriateness in Dementia Patients (IA-ADAPT) Website

Developed with the support of the Agency for Healthcare Research and Quality, the IA-ADAPT website helps clinicians, providers, and consumers better understand, assess and address challenging behaviors in people with dementia using evidence-based approaches. It includes user-friendly resources such as brief videos, written content, quick reference guides for clinicians and providers, and information for families or patients on the risks and benefits of antipsychotics for people with dementia.

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