Improving Nursing Home Compliance via Revised Antipsychotic Use Survey Tool

OBJECTIVE: To analyze the effect of using a pharmacist-initiated antipsychotic use survey tool on improving nursing home compliance for appropriate antipsychotic use in patients with dementia.

DESIGN: Prospective chart review study.

SETTING: Two nursing homes in Marin County, California.

PARTICIPANTS: Nursing home residents diagnosed with dementia and receiving antipsychotic medication.

INTERVENTION: Pharmacist performing survey tool screening for appropriate antipsychotic use based on Centers for Medicare & Medicaid Services guidelines and using information from the survey tool as part of the pharmacist recommendations to the prescriber.

MAIN OUTCOME MEASURES: Number of pharmacist recommendations indicated by the survey tool for antipsychotic gradual dose reduction (GDR) or discontinuation that are accepted by prescribers. Number and percent of residents on antipsychotic medication per nursing home prior and throughout the study period.

RESULTS: Of the final 20 study population residents, 12 were survey-recommended for GDR or antipsychotic discontinuation. Within the 12 recommendations, four were accepted by prescribers from one of the two nursing homes. Decline in antipsychotic use was observed in the same nursing home throughout the seven months from 28 residents (21%) to 19 residents (14%). No significant difference in antipsychotic use before and after intervention was observed in the other nursing home. Overall feedback reported intervention helpful and requested continued pharmacist involvement.

CONCLUSION: Nursing home compliance improved and antipsychotic use declined during pharmacist intervention at one nursing home. Multiple factors may be involved in pharmacist recommendation acceptance.