Antipsychotics

SuesquatchRN, BSN, RN · Mar 9, 2010

Oh, please. Being old with dementia has an increased risk of death.

And why isn't dementia considered a psychosis? Because it's organic? News flash, government. So are the psychoses.

debRN0417 · Mar 9, 2010

We all know that antipsychotics are dangerous for the elderly, but most dementia behaviors respond to these medications. I guess it all comes down to getting a psych diagnosis for the use, do the monitoring and it is what it is. Now that I think about it, aren't antipsychotics dangerous for anyone? They have bad side effects not only for the elderly, but for the general population as well.

Don't get me started on the lack of geri-psych treatment facilities....

DaniLPN2RN · Mar 9, 2010

And without those medications most Residents are a danger to themselves and the staff. I spent the better part of Sunday getting the tar beat out of me by a Resident they are weaning from the medication. Ended up baker acting her by the end of the day. Would it not have been better to let her continue her medication? She was a very pleasant lady before.

While I feel some are over medicated, other really benefit from those meds.

K.P.A. · Mar 9, 2010

Oh, please. Being old with dementia has an increased risk of death.

Increased by ignoring black box warnings and inappropriately administering antipsychotics?

And why isn't dementia considered a psychosis? Because it's organic? News flash, government. So are the psychoses.

You too may be organic!

SuesquatchRN, BSN, RN · Mar 9, 2010

Increased by ignoring black box warnings and inappropriately administering antipsychotics?

Huh? I have yet to work in a facility in which the physicians and nurses did not weigh the risks and benefits closely. And my father's last year was made much pleasanter for everyone, especially him, with the use of some risperidone.

The restrictions placed on LTC are ridiculous. The expectations of what can be done for declining, elderly people are unrealistic and the options available to us to deal with dangerous and disturbing, often to the person displaying the, behaviors are extremely limited.

CapeCodMermaid, RN · Mar 9, 2010

ANY medication we give comes with risks....Coumadin is one of the worst, most dangerous drugs, yet we give it freely. It's all about the risk vs. the benefit. Is it risky to give zyprexa or risperdal to an elder? Probably, but is it better for them to be tormented by hearing voices? I doubt it.

NTexasRN · Mar 10, 2010

March 08, 2010
BOSTON-Federal officials say nearly 2,500 Massachusetts nursing home residents were given powerful antipsychotic drugs last year that were not intended or recommended for their medical condition.
The Boston Globe reports that data collected by the Centers for Medicare and Medicaid Services show that 28 percent of Massachusetts nursing home residents were given antipsychotics in 2009. Of that group, more than one out of every five did not have a medical condition that called for such treatment.
More Times Breaking News
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Federal officials say the drugs are often given to patients with dementia, which puts them at risk for serious side effects, even death.
An official with the organization that represents the state's nursing homes acknowledges that the number is too high and says better training is needed.
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Information from: The Boston Globe
Can you say DUH? We all know antipsychotics aren't the best choice for older people or people with dementia, but as long as the hospitals keep sending us people with behaviors, because there aren't enough long term geri-psych beds available, we'll have to keep using these drugs.

All this means is that the nurse who took the order failed to put the correct diagnosis upon the MAR.

morte, LPN, LVN · Mar 10, 2010

All this means is that the nurse who took the order failed to put the correct diagnosis upon the MAR.

not at all, nurses can not provide a medical diagnosis.....must come from doc.....

Long Term Care Columnist / Guide · Mar 10, 2010

Huh? I have yet to work in a facility in which the physicians and nurses did not weigh the risks and benefits closely. And my father's last year was made much pleasanter for everyone, especially him, with the use of some risperidone.
The restrictions placed on LTC are ridiculous. The expectations of what can be done for declining, elderly people are unrealistic and the options available to us to deal with dangerous and disturbing, often to the person displaying the, behaviors are extremely limited.

Yes, I find it exceedingly ironic that the folks who make the rules that force us to try to 'wean' people off antipsychotics are so far removed from the bedside that they have NO CLUE what we deal with every single day. I suspect most of them wouldn't recognize dementia with psychotic features if it (literally) belted 'em in the schnozz.........I'm not a fan of routine administration of these drugs either, but there are some nights when I'd give almost anything for a little Vitamin "H" for the lady down the hall who screams for hours on end, or some Ativan for the gentleman who whales the tar out of the aides who are just trying to do pericare so his skin doesn't break down any worse than it has already. :uhoh3:

noc4senuf · Mar 10, 2010

Every single antipsychotic in our building has the "appropriate" diagnosis to please CMS and the surveyors. Our MD's and NP's work well with us and realize that we can not have them in use without them.

Nascar nurse, ASN, RN · Mar 10, 2010

Every single antipsychotic in our building has the "appropriate" diagnosis to please CMS and the surveyors. Our MD's and NP's work well with us and realize that we can not have them in use without them.

But last I knew (& I've been out of MDS for a year or so now so don't beat me if I'm wrong), but it has to be coded correctly on the MDS for the quality indicators to capture the actual diagnosis with the use of the antipsychotic. If not within the first 2 lines of the empty spots in section I then the quality indicators indicate as not having the appropriate diagnosis. Did that even make any sense? I will have to double check my facts tomorrow at work when I have my resources available. Can anyone help me out with this?