Implementing Psychopharmacology Rounds in a Nursing Facility to Improve Antipsychotic Usage

OBJECTIVES: Evaluate whether implementing of pharmacy-led psychopharmacology rounds in a nursing facility will improve the rate of antipsychotic use.

DESIGN: Single-center, prospective; medication use evaluation (MUE).

SETTING: Rutland Nursing Home, Brooklyn, New York.

PARTICIPANTS: Nursing facility residents, excluding the pediatric unit.

INTERVENTIONS: Weekly interdisciplinary psychopharmacology rounds that include: clinical pharmacists, nurse managers, medical director, social workers, and administration. Antipsychotics were analyzed for all residents for appropriateness of use, proper documentation, and adequate monitoring.

MAIN OUTCOME MEASURE: Assess the overall rate of reduction of antipsychotic use after implementation of psychopharmacology rounds. Secondary outcomes assessed improvements in monitoring and documentation for residents on antipsychotics.

RESULTS: A total of 81 residents were evaluated over the six-month MUE. Of those residents, 20 had their antipsychotics discontinued, and 11 had their antipsychotics tapered. The overall use of antipsychotics decreased from 14.6% (62/422) to 12.2% (50/411) (P = 0.285). Compliance with indications generally approved by the Centers for Medicare & Medicaid Services improved from 65% (37/57) to 85% (46/54) (P = 0.008). Matching indications on the psychiatry consult and the medication order improved from 58% (33/57) to 80% (43/54) (P = 0.015). Metabolic laboratory monitoring improved from 58% (33/57) to 83% (45/54) (P = 0.003). Improvements in timeliness of psychiatry and ophthalmology consults were not statistically significant.

CONCLUSION: Implementing interdisciplinary psycho-pharmacology rounds in a nursing facility resulted in a reduction of inappropriate antipsychotic use and improved monitoring and documentation.