B3 Action Plan for psychoactives

[Shell5]

I seem to have the same problem every week at the long term care facility where I work. We only have 2 people on antipsychotices, but our antianxieties and antihypnotics seem to stay the same and cause us to be over benchmark.

I have tried everything to get them DC'd, but a lot of residents and/or their family do not want them DC'd or the dr. does not want to DC them.

I keep putting the same thing under plan of action every month for plan of action and would like to at least to do someothing else but I feel stuck. I don' t know what esle to do. Can someone help me? Does anyone have any ideas what to suggest to the doctors? It seems like they automatically jump to an antianxiety of antihypnotic.

Help!!!!

Thanks.

[morte, LPN, LVN]

perhaps they are needed??

[Shell5]

Maybe I did not make myself clear. I realize some of them are needed. I do think that the Dr./NP could try something else first like Trazadone or something else instead of going straight to the antihypnotic. I suppose I need to be addressing this to a pharmacist. What I really want is to prevent our benchmarks from increasing. I would like to see our numbers stay the same or decrease intead of increase every month. I hate this part of my job.... trying to maintain the benchmarks. I know I am a nurse and I am a patient advocate, but I do think sometimes there are things we can try before we automatically go to the stronger meds. If anyone has any experience with what I am going through I would appreciate your input.

Thank you.

[morte, LPN, LVN]

Maybe I did not make myself clear. I realize some of them are needed. I do think that the Dr./NP could try something else first like Trazadone or something else instead of going straight to the antihypnotic. I suppose I need to be addressing this to a pharmacist. What I really want is to prevent our benchmarks from increasing. I would like to see our numbers stay the same or decrease intead of increase every month. I hate this part of my job.... trying to maintain the benchmarks. I know I am a nurse and I am a patient advocate, but I do think sometimes there are things we can try before we automatically go to the stronger meds. If anyone has any experience with what I am going through I would appreciate your input.

Thank you.

I am a simple staff nurse...so what does the term "benchmark" mean in this context?

[Shell5]

A simple staff nurse? Never minimize what you do or how hard you had to work to get to where you are. We all had to start somewhere. Benchmarking is the process of comparing one's business processes and performance metrics to industry bests or best practices from other industries. Most facilitites do this. My facility sets certain percentages that say this facility cannot have over this many pressure sores, residents on psychotropics, UTI's, ect and if you go over this percentage you have to do what is called a B3 (plan how you are going to get these percentages/benchmarks down.) These things like pressure sores, UTI, psychoactives, falls, med errors are what others look at when showing if a nursing home is providing quality of care. If you go online you will be able to compare nursing homes. It is good to have your numbers down as it shows you are providing quality of care. I hope I clarified.

[amoLucia]

A simple staff nurse? Never minimize what you do or how hard you had to work to get to where you are. We all had to start somewhere. Benchmarking is the process of comparing one's business processes and performance metrics to industry bests or best practices from other industries. Most facilitites do this. My facility sets certain percentages that say this facility cannot have over this many pressure sores, residents on psychotropics, UTI's, ect and if you go over this percentage you have to do what is called a B3 (plan how you are going to get these percentages/benchmarks down.) These things like pressure sores, UTI, psychoactives, falls, med errors are what others look at when showing if a nursing home is providing quality of care. If you go online you will be able to compare nursing homes. It is good to have your numbers down as it shows you are providing quality of care. I hope I clarified.

Very clear explanation - thank you for being so comprehensive. I knew what it was about, but you explained it so very well.

[morte, LPN, LVN]

thanks, I am sorry that that is considered a lack of good care. Now, to me, psychoactive includes antidepressants, so this REALLY opens up a kettle of fish! In general, I would think that persons that are in need of psychoactive meds would be more likely to be difficult for families to deal with, and hence, be more likely to be placed in long term care, skewing your stats. Do they include compazine in this mix? In larger doses it is an antipsychotic...sometimes the computer at the pharm will flag it. You need GOOD nursing documentation that the current medication regimen is effective for patient, ie is operating at the highest level possible for that patient. If you accept for admission a known psych patient, with pre existing psych meds, that have proven to be effective, trying to change them would seem, to me, to be inherently wrong. "if it ain't broke, don't fix it."

[CapeCodMermaid, RN]

There is no such thing as an"antihypnotic". The term is hypnotic. There are anti-psychotics, anxiolytics, antidepressants but NO antihypnotics

[Psychcns]

I have done some consultations to nursing homes as a psych np.. I always check with staff about what I recommend. One place did not want antipsychotics and we would try trazadone or mood stabilizers, first, depending on the symptoms.. In another place we had to attempt gradual dose reductions on stable patients if possible. If you have psych evaluate pts we will likely recommend meds because they work.

[CapeCodMermaid, RN]

We all know there is a difference between dementia and psychosis. Unfortunately, for years residents with dementia were given antipsychotics for behaviors that might have been mitigated by a more personal approach. Some old people truly are psychotic and need medication so they won't be tortured mentally. Make sure your documentation is rock solid.