TY - JOUR
T1 - Deficiency Citations on Inappropriate Psychotropics Use Related to Care for Behavioral Symptoms of Dementia
AU - Yoon, Jung Min
AU - Trinkoff, Alison M.
AU - Galik, Elizabeth
AU - Storr, Carla L.
AU - Lerner, Nancy B.
AU - Brandt, Nicole
AU - Zhu, Shijun
N1 - Funding Information:
This study was supported by the 2019 Small Grant from the Sigma Theta Tau International Honor Society of Nursing (PI: Jung Min Yoon).
Publisher Copyright:
© 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2022/11
Y1 - 2022/11
N2 - Objectives: The Centers for Medicare and Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists. Nursing homes (NHs) can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The purpose of this study was to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for NH residents with dementia. Design: A mixed-methods study was performed. Setting and Participants: During the first quarter of 2018 (January–March), 3526 NHs were surveyed, of which 642 received F-758 tags. Of the 642, the sample was confined to the 444 NHs that received the citation for the care of residents with dementia. Information on deficiencies was obtained from 2018 Certification and Survey Provider Enhanced Reporting data. Inspection reports for deficiencies were obtained from Centers for Medicare and Medicaid Nursing Home Compare and ProPublica. Methods: Quantitative analysis was used to examine the frequency of involved psychotropic medications, scope/severity of F-758 deficiency citations, and reasons for the citations. Reasons for F-758 citations by psychotropic medication categories and scope/severity of the citations were also examined using χ2 tests. Qualitative data analysis was conducted using content analysis with an inductive coding approach to summarize the inspection reports. Results: Antipsychotics were the most involved drug category for F-758 tag citations. The 3 most common reasons for F-758 citations included failure to identify and/or monitor behavioral symptoms (178 NHs), attempt gradual drug reduction (131 NHs), and maintain 14-day limitations on Pro Re Nata (PRN) psychotropic orders (121 NHs). Compared with those with no involvement of antipsychotic drugs, facilities with antipsychotics-related F-758 tags had higher rates of failure to identify/monitor behavioral symptoms (P <.001), attempt gradual drug reduction (P <.001), and provide adequate indications for psychotropics use (P <.001). NHs with F-758 tags related to inappropriate antianxiety medication use had a higher prevalence of failure to maintain 14-day limitation on PRN orders (P <.001) and provide nonpharmacologic interventions (P <.001). Conclusions and Implications: This study suggests areas for improvement that could potentially reduce inappropriate psychotropics use. Supporting quality of dementia care workforce and improving cooperation within healthcare staff and professionals are recommended to ensure proper nonpharmacologic and pharmacologic interventions.
AB - Objectives: The Centers for Medicare and Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists. Nursing homes (NHs) can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The purpose of this study was to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for NH residents with dementia. Design: A mixed-methods study was performed. Setting and Participants: During the first quarter of 2018 (January–March), 3526 NHs were surveyed, of which 642 received F-758 tags. Of the 642, the sample was confined to the 444 NHs that received the citation for the care of residents with dementia. Information on deficiencies was obtained from 2018 Certification and Survey Provider Enhanced Reporting data. Inspection reports for deficiencies were obtained from Centers for Medicare and Medicaid Nursing Home Compare and ProPublica. Methods: Quantitative analysis was used to examine the frequency of involved psychotropic medications, scope/severity of F-758 deficiency citations, and reasons for the citations. Reasons for F-758 citations by psychotropic medication categories and scope/severity of the citations were also examined using χ2 tests. Qualitative data analysis was conducted using content analysis with an inductive coding approach to summarize the inspection reports. Results: Antipsychotics were the most involved drug category for F-758 tag citations. The 3 most common reasons for F-758 citations included failure to identify and/or monitor behavioral symptoms (178 NHs), attempt gradual drug reduction (131 NHs), and maintain 14-day limitations on Pro Re Nata (PRN) psychotropic orders (121 NHs). Compared with those with no involvement of antipsychotic drugs, facilities with antipsychotics-related F-758 tags had higher rates of failure to identify/monitor behavioral symptoms (P <.001), attempt gradual drug reduction (P <.001), and provide adequate indications for psychotropics use (P <.001). NHs with F-758 tags related to inappropriate antianxiety medication use had a higher prevalence of failure to maintain 14-day limitation on PRN orders (P <.001) and provide nonpharmacologic interventions (P <.001). Conclusions and Implications: This study suggests areas for improvement that could potentially reduce inappropriate psychotropics use. Supporting quality of dementia care workforce and improving cooperation within healthcare staff and professionals are recommended to ensure proper nonpharmacologic and pharmacologic interventions.
KW - behavioral symptoms
KW - deficiency of care citations (F-758)
KW - Dementia
KW - inappropriate psychotropic medication use
KW - nursing home residents
UR - http://www.scopus.com/inward/record.url?scp=85130909716&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2022.04.006
DO - 10.1016/j.jamda.2022.04.006
M3 - Article
C2 - 35568094
AN - SCOPUS:85130909716
SN - 1525-8610
VL - 23
SP - 1772
EP - 1779
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 11
ER -