Patient Engagement Key to Reducing Antipsychotic Medications in Oklahoma Nursing Home

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Southern Hills Success Story

From his motorized wheel chair, Bill Turley waves to friends along the hallways at the Villages of Southern Hills, a long-term care facility and his home in Tulsa, Oklahoma. Family pictures and musical instruments adorn his room there. He talks about his love for music and his respect for the English program at Oklahoma State University, his alma mater. He serves as the president of the Villages resident council. He enjoys writing and Internet surfing, he plays multiple musical instruments, and he rides an oversized trike in the courtyard of the home.

Bill is living life more fully since his health care providers engaged him in the decision to come off his antipsychotic medication that was no longer medically necessary.

Risks of long-term use of antipsychotics include delirium and confusion, uncontrolled movement disorders, incontinence, pneumonia, low blood pressure, stroke and sudden death.

In 2012, the Centers for Medicare & Medicaid Services (CMS) launched an initiative aimed at safeguarding nursing home residents from the risks of unnecessary antipsychotic medication. Based on the initiative’s initial success, the work is being continued by Quality Innovation Network-QIOs (QIN-QIOs) and national partners over the coming four years.

I think involving the patient and family is the number one thing. The best way to approach them is by education.”

OFMQ, through the CMS 10th Scope of Work QIO Program (20112014), developed a partnership with the Oklahoma State Health Department, the Alzheimer’s Association and more than 100 nursing homes to push antipsychotic medication reduction in Oklahoma’s nursing homes. OFMQ launched an 18-month Journey to Quality program, through which nursing homes join together in regional community meetings and virtual sessions to learn and share challenges and best practices for improving dementia care.

The Villages was an active participant in OFMQ’s Journey to Quality program. The team at this home believes partnering with families and residents has been an important component of antipsychotic medication reduction.

Bill had been on a combination of medications including antipsychotics and antidepressants for approximately 10 years. He’s struggled with depression and he says he’s always had trouble sleeping.

The Villages’ medical director, Dr. Farshid Zandi, explained how they improved Bill’s situation.

I think involving the patient and family is the number one thing,” said Zandi. The best way to approach them is by education.”

Talking through the medications and risks, providing a plan for medication reduction, and reassuring the patient and family that medications can always be started again if symptoms return have been integral to success, Zandi said. After engaging Bill in discussions about reducing the medication, he agreed to work with the care staff and give it a try.

The results have been great. He’s more active; he’s more alert. He seems like he’s happier,” Zandi said.

Zandi encourages physicians to be intentional and proactive about reviewing medications, especially for patients who have been on combinations of drugs for long periods.

Another key to success at the Villages is working as a team. Front line staff and nurses help Zandi make more informed and efficient decisions.

Bill has advice for patients too: He says they need to be proactive in getting what they need.

Adapted from a case study developed by OFMQ; Nursing homes interested in connecting with their current regional QIN-QIO may locate them here.