MedOptions’ Tip of the Month
Tip #1: “Low hanging fruit”
Short-term Patients: As a starting point, focus on patients for Gradual Dose Reduction (GDR) who have recently been admitted from the hospital on antipsychotic medication (i.e. for Delirium).
Long-term Residents: As a starting point, work with your pharmacy consultants to identify residents with Dementia who are on a low-dose of antipsychotic medication (and who have not been seen by your behavioral health providers recently) and initiate gradual dose reduction.
Don’t use antipsychotic medications for anxiety or insomnia alone. Primary care providers tend to overuse in community. Target residents who were admitted on an antipsychotic to manage anxiety or insomnia and initiate a gradual dose reduction. Substitute with more appropriate medications. Reserve antipsychotic use for severe behavioral and psychological symptoms (BPSD) and psychosis.
Tip # 3
When initiating a Gradual Dose Reduction, make it your standard practice to involve your psychologist or social worker behavioral health consultant at the outset of the GDR to monitor and treat the potential development of behavioral disturbances. This will allow for earlier integration of non-pharm strategies to manage challenging behavior.
Tip # 4
Keep in mind that chronic psychotic illnesses like Schizophrenia can be managed with lower doses in the elderly than earlier in their lives (especially if they WERE smokers). So this is a form of GDR that DOESN’T result in complete discontinuation, but lowers the risks of the medicines. It is important not to go too low, or you are risking hospitalization.
Remember there are risks involved with discontinuing an Antipsychotic Medication. This is why reductions should be GRADUAL. Return of paranoid delusions and aggression, pose safety risks for other residents and puts the facility in jeopardy for a DPH citation. Anyone can go into a skilled nursing facility and discontinue most or all orders for these drugs. But this is not good medicine.