Hi-Desert Medical Center’s Continuing Care Center has earned recognition for safely reducing the off-label use of antipsychotics by the American Health Care Association’s (AHCA) Quality Recognition Program.
According to the AHCA, a large number of the individuals in skilled nursing centers are living with some type of dementia. For these individuals and as illness progresses, behavior often becomes a key form of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior. The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and 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 death, falls with fractures, hospitalizations and other complications resulting in poor health and high costs.
Michelle Amdahl, the Continuing Care Center’s director of nursing and interim administrator, explains staff at the CCC works diligently to reduce the use of antipsychotics, and the process begins upon admission. “Staff works closely with the resident’s physician, the pharmacy and an interdisciplinary team to gradually reduce dosages, with the goal of discontinuing these drugs altogether,” she says. “Our goal is always quality of care and the best home-like environment for our residents. Decreasing the use of any unnecessary medications in the long-term care setting adds to the quality of life of our residents.”
The intent of the AHCA Quality Initiative goal to safely reduce the off-label use of antipsychotics is to encourage alternative strategies for responding to challenging behavioral expressions in persons living with dementia before considering medications and to ensure that antipsychotic medications, when used, are as appropriate and safe as possible.