decreasing psychotropics in the elderly

[motherof3sons]

so our management team is on a new kick, weaning psychotropics on residents without a psyche dx. All well and good, but the CNA's that work with me are getting the living h##l beat out of them.

We have one resident that is 1:1 and when disrupted from going into others rooms, not allowing her to take food off of others plates, kept from hitting other residents or any other various thing. She slaps, pinches, grabs ect and the management still thinks weaning her off Seroquel is a good thing.

How many more times can I say "sorry you got hit, slapped" to these CNA's that work their butts off for meager pay??

How do you all deal with such things?

[ktwlpn, LPN]

GDR's are a federal regulation,it's really not your management's aim to make everyone's life miserable.It truly comes back to nursing and documentation. The cna's have to report those behaviors to you and you have to document them every shift.

As for your 1 to 1 lady, it looks like the Seroquel is not really effective if her behaviors are continuing to be so extreme. I've dealt with more then a few folks in that stage of dementia and in my experience there is no magic pill. A little Ativan or Xanax may take the edge off but their brains are broken and all you can do is keep them and their peers safe (from each other) and try to decrease the triggers in the environment (all of the usual-pain,toileting, thirst, increased noise at meal times is a big trigger, too) Each stage typically lasts about 18 months-hopefully the resident will get past this soon.

[systoly]

being assaulted is a recordable

are you filing reports?

[VivaLasViejas, ASN, RN]

It's not just the feds that are making our lives hell in LTC. Evidence has come to light showing that elderly patients taking atypical antipsychotics for dementia-related behaviors are at a higher risk of death (usually due to heart disease, which APs tend to make worse). That's some serious stuff, but then, these are some pretty serious medications which tend to be overused in the elderly to stop unwanted behaviors such as combativeness, screaming, spitting, and cursing. Most of the time these patients don't even have a psychiatric diagnosis to justify the medication's use, hence the regulations.

[chrisrn24]

Document!

If there is a proven need they will put the people back on them.

[VANurse2010]

I'd say assault-prevention is a valid use for these medications... but it's this kind of BS is the reason why I don't do LTC/SNF any more.

[ktwlpn, LPN]

It's not just the feds that are making our lives hell in LTC. Evidence has come to light showing that elderly patients taking atypical antipsychotics for dementia-related behaviors are at a higher risk of death (usually due to heart disease, which APs tend to make worse). That's some serious stuff, but then, these are some pretty serious medications which tend to be overused in the elderly to stop unwanted behaviors such as combativeness, screaming, spitting, and cursing. Most of the time these patients don't even have a psychiatric diagnosis to justify the medication's use, hence the regulations.

A large portion of our dementia residents are on palliative care and their loved ones have accepted there are trade off's...There is no magic pill but they'll choose comfort for today over misery through next week.At least the realistic ones who have educated themselves or have been open to our attempts to give them information have made that choice.We start that education upon admission-they have to understand that Alzheimer's is a terminal disease and other dementias are life limiting.

[motherof3sons]

I am well educated with the risks, just very frustrated with how management is going about it. Our owner who is an RN has taken it upon herself to intervene and make all kinds of med changes way too quickly...and these behaviors started after weaning of Seroquel started. We do document, every single hit, bite scratch, I provide employee incident reports, but often the CNA's are just like "why bother, it doesn't do any good". We have had a huge increase in resident:resident altercations also.

The fed mandate was to decrease psychotropics by 15% and our facility only has 8 at risk residents. But management is looking to be rid of all psychotropics on residents with no psyche dx.

Frustrating to say the least and really it must at some level be hard for the resident who has all these behaviors and what about their mental comfort?

[bluegeegoo2, LPN]

We got a visit from DADS (Department of Aging and Disability Services) here in Texas from a state pharmacist who told us that so long as there was a valid reason, as documented by the MD, (must be by the MD) that a psychotropic should not be reduced that the med did not have to be reduced. Historically, MD's would simple write or check "no" on the pharm req and that was that. Not anymore. I would, and will implore MD's to spell out their reasoning for keeping psych meds as written for the very reasons you have described above. CMS will accept the MD's reasoning, no reason why you're owner should not.

[rcdmichelle]

Management needs to understand that done residents actually need these meds. You as the nurse document the responses to the med changes and present it. They won't want the state on them