Citizens Memorial Hospital | Vitality | Winter 2018

LONG-TERM CARE The headline in a recent Washington Post article asked the question, “Why are nursing homes drugging dementia patients without their consent?” The author traveled to 100 nursing homes across six states to research the use of antipsychotic drugs in long-term care facilities. Often patients with Alzheimer’s disease or other forms of dementia are admitted to long-term care facilities and given antipsychotic medication to help with their symptoms. Frequently, the medication only slightly limits the symptoms and instead causes fatigue and sedation. “Antipsychotics and other psychoactive medications are a focus, as they have a high risk of side effects in older patients, including increased confusion and increased risk of falling,” says Cynthia Hadfield, PharmD, CMH Long-Term Care Consultant Pharmacy and Retail Pharmacy clinical manager. “However, when needed and used at the CMH long-term care reduces antipsychotic medication use appropriate dose, mood- and mind- altering medications can significantly improve the residents’ functional ability and quality of life.” Citizens Memorial Health Care Foundation long-term care facilities partner with CMH physicians and pharmacists to reduce the use of antipsychotic medications in all of its facilities. “At CMH, we have monthly interdisciplinary team meetings involving everyone from the facility administrator and director of nursing to the physician,” Hadfield says. “During this meeting, we carefully review each resident who is on an antipsychotic and determine the appropriateness of dose reduction. Medications should enable, not disable, and we work hard to make sure medication and the combination of medications is doing the resident more good than harm.” The Centers for Medicare & Medicaid Services (CMS) created the National Partnership to Improve Dementia Care to initially focus on reducing the use of antipsychotic medications. The larger mission of the partnership is to enhance the use of non- pharmacologic approaches and person- centered dementia care practices. “We focus on using these medications in the most appropriate dosage in only the residents who truly need them. CMH has been very successful at keeping our percentages low compared to the national average,” says Kelli Kruthoff, PharmD, CMH clinical pharmacist. “CMH long-term care facilities’ combined average utilization rate from June 2017 to May 2018 was 14.3 percent. As of July 2018, three of six CMH long-term care facilities were at or near goal. Keeping these numbers low is a constant battle. We make every effort to reduce antipsychotics when possible and adhere to all CMS requirements for gradual dosage reductions.” Where do we go from here? CMS recently announced a new national goal, involving a 15 percent reduction of antipsychotic medication use by the end of 2019 for long-stay residents in those homes with currently limited reduction rates. This goal builds on the progress made to date and expresses the partnership’s commitment to continue this important effort. Kelli Kruthoff, PharmD, CMH clinical pharmacist Cynthia Hadfield, PharmD, CMH Long-Term Care Consultant Pharmacy and Retail Pharmacy clinical manager For more information about CMH’s long-term care facilities, call 417-399-1818 . citizensmemorial.com 15