GDRs
These psychotropic medications have a limited timeframe to 14 days unless a longer timeframe is deemed approprite by the attending physician or the prescriscribing practitioner.
What is PRN (As Needed)?
Hypnotics are often referred to as this.
What are sleeping pills?
Class of drugs that include both natural substances derived from the opium poppy plant and synthetic or semi-synthetic compounds created in laboratories. They are often referred to as this.
What are Narcotics.
Primarily used to manage symptoms of psychosis, including schizophrenia, schizoaffective disorder, and bipolar disorder.
What are Antipsychotics?
Primary function is to reduce or eliminate the symptoms of excessive worry and fear, feelings of dread and uneasiness, panic attacks, and physical symptoms like muscle tension, rapid heart rate, sweating, and trembling.
What is an Antianxiety?
Used to treat symptoms of mental health conditions such as anxiety disorders, chronic pain, and addictions. These drugs are classified into categories based on their chemical structures and affect Serotonin in the brain.
What are Antidepressants?
Upon entering Ms. Jackson’s room, you observe the blinds are closed and the room is dark. Ms. Jackson is sitting in a chair next to her bed and she is observed to be tearful. There is a TV in the room, but it is not on. While interviewing Ms. Jackson she says she has very little interest in activities and misses her family. She tells you she likes to read but when she starts a book her mind drifts off and she finds herself crying and is unable to read the book. Ms. Jackson is in need of this type of medication.
What is an Antidepressant?
(True or False)
The surveyor must list ALL medications the resident is taking in their investigation notes for unnecessary medication investigations.
What is False.
Only the medications included as psychotropic medications should be listed.
What is the GDR timeframe breakdown requirements? (Hint: There are 4)
What is.......
1. First year: For residents admitted on a psychotropic medication or initiated on one after admission, facilities must attempt a GDR within the first year.
2. Attempt frequency: Within the first year the GDR should be attempted in two separate quarters, with at least one month between the attempts.
3. Ongoing GDR: Following the first year, GDRs should continue to be pursued, unless clinically contraindicated, with adjustments occurring in the modest increments over adequate periods to minimize withdrawal symptoms and monitor for symptom recurrence.
4. Documentation of Contraindications: If a GDR is clinically contraindicated, the rationale for this decision must be clearly documented in the resident's medical record.
This drug, although commonly used in a nursing home to assist with sleep, is not considered a hypnotic.
What is Melatonin?
This is the function of Opioid medication.
What is to reduce moderate to severe pain.
A mental state characterized by a loss of contact with reality.
What is Psychosis?
Under this tag number, anxiolytics cannot be prescribed or administered for symptoms such as wandering, verbal uncooperativeness, restlessness, general unsociability, or a refusal to participate in facility activities. Using drugs to suppress these behaviors can be cited as a chemical restraint.
What is F758?
A drug that increases urine production to remove excess fluid and salt from the body.
What are Diuretics?
You enter Mr. Hampton’s room and observe him resting in bed. He is clean and groomed and there are no odors present. You observe a urinary catheter drainage bag attached to the bedframe and the urine appears medium yellow in color and cloudy. He tells you he has a urinary tract infection (UTI) and is taking medication for the infection but is unsure of the name of the medication and is also unsure if the infection is improving. He is taking this class of medication.
What are Antibiotics?
(True or False)
The Monthly Medication Regimen Review (MRR) may be done by a facility staff member if the Pharmacist is unavailable to perform the review for the month.
What is False?
This task MUST be performed monthly by the Consultant Pharmacist and documented in the medical chart the review was done with no concerns, or the facility will have a book listing all residents reviewed by the Pharmacist for each month.
The stepwise tapering of a dose of medication to determine if symptoms, conditions, or risks can be managed by a lower dose or if the dose or medication can be discontinued.
What is a Gradual Dose Reduction (GDR)?
Federal regulations dictate that hypnotic medications should only be used after this has been attempted.
What is after non-pharmacological interventions have been tried, documented, and deemed insufficient?
The most common side effect of Opioid medication.
What is constipation?
Unlike other psychotropic classes where a physician can extend a PRN order after an evaluation, CMS rules dictate that a PRN antipsychotic order cannot be extended or rewritten beyond how many days unless the attending physician or prescribing practitioner evaluates the resident in person (or via valid telehealth), documents a highly specific clinical rationale, and writes a brand new order.
What is 14 days?
This must document a highly specific, valid medical diagnosis (e.g., Generalized Anxiety Disorder, Panic Disorder, or situational anxiety from an acute, severe stressor) where the anxiety causes clear, documented distress or functional impairment to the resident.
What is the clinical record?
A type of antimicrobial substance active against bacteria.
What are Antibiotics?
You enter Mr. Denver’s room, and you notice multiple areas of bruising on both of his arms. He indicated he has not had a fall and said he bruises easily and has occasional nose bleeds. You would consider he may be taking this class of medication.
What are Anticoagulants?
A resident admitted to the facility on a psychotropic medication and has been in the facility less than a year. Upon review of the MRR you note there have been no GDRs done. Based on GDR guidance you determine this.
What is there is no deficient practice. (You document the residents admission date and that no GDR has been done yet.)
First year: For residents admitted on a psychotropic medication or initiated on one after admission, facilities must attempt a GDR within the first year.
These medications should be included in consideration for a GDR, (and investigated under "unnecessary medications") by the pharmacist if prescribed by a physician even if the medication is not classified as an antipsychotic or anti-psychotropic medication but is used to manage symptoms often associate with mental health conditions
What are "Off Label" medications.
Examples include: Beta Blockers, anticonvulsants, and stimulants.
This monitoring by the facility is necessary for hypnotics as sedative-hypnotics carry well-documented risks of residual next day sedation, cognitive impairment, and motor unsteadiness in the elderly.
What is side effect monitoring?
Considered this by Federal Regulations if it is given for an excessive duration or without a valid clinical indication.
What is unnecessary?
Under F605, a facility must prove this before initiating an antipsychotic medication for any resident
What is absolute clinical necessity?
The consultant pharmacist acts as the regulatory compliance filter. When a concern is identified for a psychotropic medication who must the pharmacist issue a formal written report to?
Who is the attending physician and the Director of Nursing (DON)?
Primary function is to regulate blood sugar.
What is insulin?
According to the CE Pathways, surveyors look at Insulin as an unnecessary medication for this reason.
What is insulin is in the hormone class of medication and has the potential for an adverse outcome?
If a resident is receiving THIS service the recommendations from the SESSIONS must be integrated into the resident's comprehensive facility care plan. This is a service that the surveyor would look for with a resident on psychotropic drugs.
What is Psychiatric Therapy?
These rules require their use for clear diagnosis and documented conditions for psychotropic medications, PRN psychotropic medication use and that they are only extended with documented clinical justification by the prescriber, and cannot be reordered without first evaluating the resident.
What are Federal Regulations?
Sleep-inducing medications used to initiate or maintain sleep.
What are Hypnotics?
The use of opioid medications in long-term care facilities is highly regulated by this organization.
What is the Centers for Medicaid and Medicare?
One of the most critical, predictable adverse consequences of antipsychotics is this.
What is Tardive Dyskinesia (TD)?
Antianxiety medications are in a classification of drugs also known as this.
What are anxiolytics?
Prevents unneeded blood clots from forming.
What are Anticoagulants?
This is the rationale for investigating unnecessary medications in the nursing home.
What is to protect residents from harm, such as adverse drug events, falls, and decreased quality of life, which can result from inappropriate prescribing practices like excessive doses, inadequate monitoring, and the use of drugs as "chemical restraints" for sedation or staff convenience. This focus ensures that any drug therapy is medically appropriate, timely, and supports the resident's overall health and well-being.
Any long-term care resident prescribed an antipsychotic medication must have this in place.
What is an active, quantitative behavior monitoring program in place?