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Learning Objective 1: "The learner will be able to list 2 ways to optimize use of psychotropic medications in the nursing home resident.
Learning Objective 2: "The learner will be able to identify team members necessary to optimize use of psychotropic medications in the nursing home resident.
Purpose:
The goal of this project is to improve use of psychotropic medications in nursing home residents through a collaborative team led by a gerontological nurse practitioner (GNP) and a pharmacist. The team is comprised of a psychiatric nurse practitioner, director of nursing, assistant director of nursing, dietitian, the social workers, physical and occupational therapists, unit managers, certified nursing assistance, resident, family and primary medical provider.
Background:
The use of medications to inhibit behaviors or effect mood changes, is a costly issue of constant concern for policymakers, regulators, health care researchers, and the public. Even with criteria such as the Beers list established in 1991 as a medication utilization tool for the older adult and the Omnibus Reconciliation Act enacted in 1987, optimal medication usage for nursing home residents is not being realized. Further, optimal behavioral therapy requires both effective drug therapy and non pharmacologic psychosocial care, necessitating a team approach.
Setting:
The nursing home in this project is a corporately owned, 150 bed, inner city nursing home in Omaha, Nebraska.
Methods:
Each identified resident receives a comprehensive geriatric-focused assessment, by the GNP and the psychiatric nurse practitioner. A key focus of the assessment is to determine the indication for the medication and : (1) validate indication still exists, (2) determine if medication is at optimal effect, (3) identify what non-pharmacological interventions are indicated. The pharmacist, the psychiatric NP and the GNP make recommendations to the behavior team regarding their findings. The team collaborate on workable interventions, both pharmacological and non-pharmacological, to meet the resident’s needs.
Evaluation Outcomes:
Measurements evaluated include: reduction of psychotropic medication use and the increase of non-pharmacological interventions for behavior regulation. These indicators are measured at baseline, 4 weeks and 8 weeks after comprehensive assessment.
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