P008: Division of Health Improvement/Health Certification Licensing and Oversight
P008: Percentage of long-stay nursing home residents receiving psychoactive drugs without evidence of psychotic or related condition
Current Value
17.9%
Definition
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Story Behind the Curve
- Nationally, over half of nursing home residents have some form of dementia, and many experience related behavioral and psychological symptoms. The US Centers for Medicare and Medicaid Services (CMS) partners with states, nursing homes, and others to improve dementia care, focusing on person-centered and comprehensive health care to significantly reduce the use of anti-psychotic medication for nursing home residents without a valid clinical reason or evaluation.
- Antipsychotic medication may contribute to falls, withdrawal, and other behaviors that harm a resident’s health or quality of life. Therefore, it is important we work toward eliminating use of these psychoactive drugs among New Mexican patients who don't have evidence of psychotic or related conditions.
- There is a two quarter lag in reporting data.
- Information is tracked through the Minimum Data Set (MDS). The Division of Health Improvement (DHI) is working toward better and more accurate use of MDS records in nursing homes.
- By sharing best practices and monitoring MDS data during the survey process, DHI can further eliminate use of anti-psychotic medication and improve quality of life for nursing home residents. Surveyors investigate onsite to ensure residents receive anti-psychotic medication when medically indicated and is appropriately monitored during annual surveys.
- This measure is explanatory; no target has been set for this measure.
Partners
- Nursing Home Facilities
- New Mexico Health Care Association
- HealthInsight
- Centers for Medicare and Medicaid Services (CMS)
What Works
- In March 2012, CMS launched a nursing fac
ility quality initiative that included a goal to decrease the off-label use of antipsychotics by 15% by December 2012. Since then, other organizations, including the American Society of Consultant Pharmacists (ASCP), have joined the effort to provide guidance on appropriate antipsychotic prescribing in nursing facilities. - DHI works with the New Mexico Health Care Association and nursing homes to share data and trends, and provide training and information regarding the CMS quality initiative.
- HealthInsight has begun providing behavior management training to direct care staff to reduce outing act behaviors reducing the need for medication to manage behavior.
- Increase public awareness of the importance of reducing the use of antipsychotics.
- Public reporting of nursing home data on the use of antipsychotics.
- CMS training for surveyors who inspect nursing homes.
- Cited deficiencies assist in the reduction of unnecessary anti-psychotic medication use.
Strategy
- DHI partners with the New Mexico Health Care Association and nursing homes to share data and trends, and provide training and information regarding the CMS quality initiative.
- HealthInsight has begun providing behavior management training to direct care staff to reduce outing act behaviors reducing the need for medication to manage behavior.
Action Plan
- Q1:
- This is a current CMS/HealthInsight performance measure. DHI will continue to meet quarterly with the HealthInsight team to come up with strategies to engage providers and nursing homes statewide to decrease anti-psychotic drug use. Completed.
- Q2:
- The New Mexico Department of Health's (NMDOH’s) newly hired MDS coordinator, who is a registered nurse, will meet with the HeathInsight team to establish a plan to assist in the accurate reporting of nursing home data. (meeting scheduled for January) Completed.
- Long Term Care (LTC) surveyors continue to enforce regulations related to use of unnecessary medications including the use of antipsychotic medications without an appropriate clinical diagnosis during the recertification Nursing Home annual surveys. Completed scheduled survey enforcement.
- HealthInsight has begun providing behavior management training to direct care staff to reduce acting out behaviors, thereby reducing the need for medication to manage behavior. Completed.
- Q3:
- MDS coordinator will send out a statewide email to provide guidance on accurate data reporting and ideas on ways to reduce anti-psychotic drug use. Completed.
- MDS Coordinator will meet with HealthInsight team in January 2018 and provide a training for Providers regarding MDS coding to ensure accurate reporting of antipsychotic use in nursing homes. Training is tentatively scheduled for March 2018. Completed.
- Q4:
- MDS coordinator will be certified in a nationally approved MDS certification program.
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