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Explore Goal

Deciding what you want to change and communicating that intention is the first step of the quality improvement cycle. This page provides a general description of the goal and its benefits to share with your team.

Medications, when used appropriately, can help promote the resident’s highest practicable mental, physical, and psychosocial well-being. Medications used inappropriately can compromise a resident’s well-being and even cause death. Ensuring that residents receive medications that are needed and appropriate for their medical condition is a critical component of safe and effective care.

Initially, this goal will focus on antipsychotic drugs, which are sometimes used to address behavioral responses in persons with dementia. Working on this goal will provide the nursing home staff with alternative non-pharmacological interventions for residents who otherwise would likely be treated with antipsychotic medications. In addition, working on this goal will provide nursing home staff with tools to assist in reconciling medications, starting with antipsychotic medications, to avoid inadvertent omissions, duplications, and incorrect dosing. The result will be better health and quality of life for residents.

  • How Does Appropriate Medication Benefit Residents?

    Inappropriate use of antipsychotics is associated with adverse effects such as death, heart attack, stroke, falls, and hospitalizations.

    Non-pharmacologic interventions may enhance quality of life for the resident.

    Non-pharmacologic interventions support a resident to function at his or her highest practicable mental, physical and psychosocial well-being.

    Non-pharmacologic interventions may enhance the relationship between residents and their family and friends as well as with staff.

    Avoiding inappropriate medications reduces the risk of medication errors.

    Non-pharmacologic interventions provide opportunities for holistic, person-centered care practices that help meet resident’s physical, social, and emotional needs.

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  • How Does Appropriate Medication Benefit Nursing Home Staff?

    Non-pharmacologic interventions may enhance the relationship between staff and residents and increase staff satisfaction.

    Engaging residents in meaningful activity may be more professionally rewarding and satisfying to staff than pharmacologic intervention.

    Non-pharmacologic interventions frequently support other nursing home quality initiatives, such as consistent assignment or person-centered care practices, which are mutually beneficial. Coordinating quality improvement initiatives leads to better outcomes for the resident, staff and the nursing home care practices.

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  • How Does Appropriate Medication Benefit Nursing Homes?

    Evidence-based tools, resources and guidance for medication reconciliation related to the use of antipsychotic medications assist the nursing home to provide a high standard of care.

    Person-centered care may lead to increased resident and family satisfaction and thus improve nursing home marketability.

    Nursing homes with satisfied staff members are able to recruit other good workers.

    Focus on non-pharmacologic interventions for persons with dementia prepares the nursing home for increased survey activity in this area.

    Litigation resulting from medication errors may be reduced.

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Step 2 – Tracking Tool  >

Tracking Tool

The Campaign Tracking Tools allow you to document your work, monitor outcomes and the processes related to your outcomes. To achieve a data-driven quality improvement project, collect data for several months to establish a solid baseline and set a target for your improvement; then continue collecting data -- charts within the workbooks and trend graphs on the website provide you and your team with the feedback you need to determine if the changes you are making are being fully implemented and if they are having the expected impact on your outcomes. Keep your workbook up-to-date on a daily or weekly basis and look at data often to support a rapid cycle quality improvement project. Download the data tracking tool and collect data for a month or so to determine your starting point.


Questions? Contact the NNHQI Campaign Help Desk: Help@nhQualityCampaign.org.

Before you start, read our Tip Sheet on Testing Change & Starting Small (PDF).

Calling All Pilot Testers!
Read our August Newsletter for more information about the new Dementia Care & Psychotropic Tracking Tool. If you’re interested in participating as a pilot tester for the tool in September, please send us an email at help@nhqualitycampaign.org.

Step 3 – Examine Process  >

Examine Process

This set of probing questions will help you evaluate your current processes and provide guidance for ways to make improvements.

  • Why is our use of antipsychotics high for individuals with dementia?

    • Has the use of antipsychotics risen over the last three months?
    • Is our use of antipsychotics more than the average for our state?
    • How does our rate compare to the national average?
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  • Which groups are affected?

    • Residents

      • Are the individuals with dementia long stay or short stay?
      • Are individuals on the same unit?
      • Are residents on scheduled antipsychotics, as needed (PRN) antipsychotics, or both?
      • Do we discuss the use of anti-psychotics with residents and/or families and gain their consent for their use?
    • Prescribers

      • Do the prescriptions for antipsychotics come from the same prescriber or are there different prescribers?
      • Are antipsychotics started outside of the nursing home (for example - hospital, outside consultant) or are the drugs started after people are in the nursing home?
      • For those whose medications are started in the nursing home is, there an assessment done prior to, or shortly after, the initiation of an antipsychotic medication?
      • Have there been conversations with the prescribers about reducing or stopping antipsychotics?
      • Have there been any consulting pharmacist recommendations to reduce the antipsychotics and were these recommendations followed?
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  • Processes and Resources to Consider

  • What practices do we have in place to minimize the use of antipsychotic medications?

    • Is there an optimum number of staff and do staffing patterns support individualized, person-centered care?
    • Does our staffing pattern provide for flexibility based on the number of persons with dementia, and/or the severity of their illness?
    • Does our staffing pattern provide adequate coverage for crisis management?
    • Is there adequate staff training on dementia and on understanding and responding to behavior as a means of communication?
    • Does support exist within the nursing home to change the utilization of antipsychotics?
    • Do staff request antipsychotics prior to assessment of a resident?
    • Do staff request antipsychotics prior to systematic attempts to identify and address unmet needs that may be triggering behavioral responses?
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  • Are there patterns of use?

    • Are there clear and acceptable clinical rationale for use of medications?
    • Are gradual dose reductions being conducted at our home?
    • Are the medications being monitored by objective measures?
    • If so, are the outcomes positive for the individual?
    • Are the medications causing adverse effects for the resident and/or change in function?
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Step 4 – Create Improvement  >

Create Improvement

Dementia Care & Psychotropic Medication Reduction

The Science of Change

  • The Circle of Success is a quality improvement framework and a guide to finding the resources you need on the website.
  • Quality Improvement Methods are evidence-based approaches for creating systemic change. This collection includes quick-start instructions, templates, and mini-videos.

Free Training

Medline University online courses:
Assessments
Adobe PDF Resident Questions Worksheet 2018
Facility Questions Worksheet 2018
Originally developed for CMS's Focused Dementia Care Survey process, these tools have been released to the public with the intent that long term care communities will use them to assess their own practices in providing resident care.
MS Word Dementia Care Critical Element Pathway
Critical Elements Pathways are used by state survey. Use Pathways to identify your strengths and your opportunities for improvement, and to plan your next steps. Routine review of Pathways supports your continuous readiness.
Website Resident Prioritization Tool for Antipsychotic Reduction
A case-by-case review of your nursing home’s use of antipsychotic and psychotropic medications will help your multidisciplinary team identify and prioritize residents who are candidates for medication reduction.
Website Improving Antipsychotic Appropriateness in Dementia Patients
Contains lectures, reference guides, and other information on appropriateness, risks, and benefits of antipsychotic medications in dementia patients.
Website Assessments and Best Practices in Care of Older Adults
Contains numerous assessment tools to assess dementia, pain, fall risk, nutrition, etc. in older adults.
Individualizing Care and Complementary Approaches to Increasing Comfort
Adobe PDF Survey Guidance on Individualizing Care
Excerpt from State Operations Manual Guidance for Surveyors: Examples of individualized, non-pharmacological interventions to help meet behavioral health needs.
Website Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia
From the Alzheimer’s Association 2018 Dementia Care Practice Recommendations.
Website Encouraging Comfort Care: A Guide for Families of People with Dementia Living in Care Facilities
From Alzheimer’s Association-Greater Illinois Chapter, this resource provides information for families and staff, with particular attention to care issues related to the late and final stages.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes
The recommendations cover fundamentals of dementia care for areas such as preventing falls, family support, pain management, food and fluid consumption, and resident wandering.
Adobe PDF Promising Practices to Reduce the Use of Antipsychotic Medications
A brief introduction and overview of potential needs residents with cognitive issues may try to communicate and ways to meet their needs.
Direct Care Staff
Website Hand in Hand Training Series for Nursing Homes: Self-Paced Online Training
Hand in Hand Training Series for Nursing Homes: Downloadable Materials for Instructor-Led Training
Created by CMS, this training provides essential dementia care and abuse prevention education for direct care staff.
Adobe PDF How to Respond When Dementia Causes Unpredictable Behaviors
The brochure contains information on common behaviors in dementia patients. It includes information on what actions to expect, how to respond to them, and solutions to help reduce the potential for problematic behaviors.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes
The recommendations cover fundamentals of dementia care for areas such as preventing falls, family support, pain management, food and fluid consumption, and resident wandering.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes - Phase 3
Phase 3 of the recommendation focuses on end-of-life care with topics such as decision making, psychosocial and spiritual support, and coordination of care.
Deprescribing & Monitoring
Website Deprescribing Guidelines for Antipsychotic Medications
Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm or no longer provides benefit. This link takes you to the Antipsychotic Deprescribing Guideline, Algorithm, and 10-minute whiteboard video on using the Algorithm.
Website Resident Prioritization Tool for Antipsychotic Reduction
A case-by-case review of your nursing home’s use of antipsychotic and psychotropic medications will help your multidisciplinary team identify and prioritize residents who are candidates for medication reduction.
Website Improving Antipsychotic Appropriateness in Dementia Patients
Contains lectures, reference guides, and other information on appropriateness, risks, and benefits of antipsychotic medications in dementia patients.
Adobe PDF Antipsychotic Medication Reference
This chart lists indications, off-label uses, and adverse/side effects for antipsychotic medications.
Consumer Awareness Tools
Website Encouraging Comfort Care: A Guide for Families of People with Dementia Living in Care Facilities
Equip yourself to ask good questions aimed at obtaining the best care for your loved ones, including a handy checklist of comfort care measures to be discussed with staff members at your long term care community.
Adobe PDF How to Respond When Dementia Causes Unpredictable Behaviors
The brochure contains information on common behaviors in dementia patients. It includes information on what actions to expect, how to respond to them, and solutions to help reduce the potential for problematic behaviors.
Adobe PDF Promising Practices to Reduce the Use of Antipsychotic Medications
A brief introduction and overview of potential needs residents with cognitive issues may try to communicate and ways to meet their needs.
Adobe PDF Assessment and Care Planning Fact Sheet
The fact sheet explains the concepts of resident assessments and care planning, and offers advice on how to increase patient/family involvement.
Adobe PDF Individualized Assessment with Behavior Symptoms
This Family Fact Sheet from The Consumer Voice provides background and guidance for a constructive care plan conference.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes
The recommendations cover fundamentals of dementia care for areas such as preventing falls, family support, pain management, food and fluid consumption, and resident wandering.
Adobe PDF Recommendations for Assisted Living Residences and Nursing Homes - Phase 3
Phase 3 of the recommendation focuses on end-of-life care with topics such as decision making, psychosocial and spiritual support, and coordination of care.
Website Alzheimer's Association Daily Care Topics
The page contains a comprehensive list of resources targeted towards caregivers with information about respite care, stress reduction, techniques to improve care, etc.
Website Pioneer Network
Pioneer Network is a network founded by health-care professionals with the goal of promoting person-directed care in long term care settings. The website includes a guide on what to look for when choosing a long-term care facility.
Website Nursing Home 411
This resource includes numerous resources for care of dementia patients, most of which concern antipsychotic medications.

Step 5 – Engage  >

Engage

Engaging stakeholders creates a robust and successful quality improvement project. Use these fact sheets to start the conversation and encourage everyone to be involved. A story board is a wonderful, visual way to engage your community in the project, keep everyone in the know about new changes that are being tested, and share your challenges and successes along the way.

Story Board Guide
Adobe PDF Storyboard guide from QAPI
Use this guide to create a compelling poster to keep your community engaged in your project, monitor your progress, and celebrate your success. Print outcome trend graphs from your Campaign account to document your change!
Medications Fact Sheets
Adobe PDF Leadership Fact Sheet
Adobe PDF Staff Fact Sheet
Adobe PDF Consumer Fact Sheet

Step 6 – Monitor & Sustain  >

Monitor & Sustain

Once you make a change or an improvement, it’s important that you continue to collect and submit your data to ensure your improvements are working.

Step 7 – Celebrate Success  >

Celebrate Success

Too often we let accomplishments pass by without notice because we are already moving on to the next step. But, it's important to take a moment to celebrate accomplishments, big and small.

A celebration program can create a spirit of community in your nursing home. Use visible awards such as certificates, plaques and other tangible rewards that can be proudly displayed. Try giving a spontaneous award from time to time to acknowledge people who are going the extra mile.

More resources on their way. Please check back soon.

Back to Goals  >

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