GDR's, what has been your experience?

[terraqueous]

I work in LTC and am just appalled at mandated gdr's (gradual dose reductions) on psychotropic drugs for our residents. They are truly my pet peeve right now, maybe in part because the powers to be at my facility are so zealously reducing medications at every turn. These are people who are stable on their current regimen--why subject them to possible worsening symptoms, depression or anxiety? Should they not tolerate the reduced dosage well, it is hard sometimes to get them back to their previous level of functioning and balance. Their physicians can deny a proposed dose reduction but it seems too often they sign off on the reduced dosage for no other reason than its mandated for the NH to attempt gdr's. I understand there is some good reasoning behind the plan, but in reality, it just seems like experimenting with these peoples' well being. What has been other experiences with gdr's?

[rensamm]

I feel your GDR pain! I hate when this happens to some of my resident's. It's like the change is almost immediate. We (resident and staff) suffer for a few weeks then they're back to their normal dose until the next GDR. It's a super annoying process especially when you have more than one resident on psychotropics.

[LoveMyBoxer99]

While I believe there is a good intention behind the concept, I agree that it does not work well for some residents. Others seem to do okay with a dosage decrease. That being said, if there have been yearly unsuccessful attempts for someone to decrease meds that keep them at optimal level of function, then those Residents should be exempt from the mandate.

It's a shame to see a blanket rule for everyone when it should be individualized to meet each person's unique needs.

[NamasteNurse, BSN, RN]

I have spoken to our pharmacist about this and he says the dose reduction is a state mandated plan to have people on the lowest dose of psych meds that will work. He said if the dose reduction cause ANY negative effects, to call the MD and explain the situation say that the dose reduction is causing such-and-such negative s/s and you would like to try going back to the regular dose. The GDR is to test if a resident can tolerate a lower dose, if it doesn't work, ie the resident has unwanted s/s then they can be put back on their dose for another 6 months to a year depending on the state you practice in.

[nervousnurse, ASN]

Wow, this is very interesting. I am very new to LTC and we have medication aides, so I had NO idea about this! ( I am so used to giving meds and knowing EVERY medication my patients are on (coming from a hospital setting)----Now, not having the time (or ability!) to know specific medication info on a gazillion residents is still difficult for me, because I like to know EVERYthing that's going on with them!

Anyway, glad to learn about GDRs--- I love this site, I learn SO much!

[Katie13LPN]

I don't have any experience with this but that seems kinda weird. Those drugs are good for you. I would be watching for suicidal thoughts and symptoms.

[Psychcns]

I think if someone is stable on a certain dose for a long period of time ie a year. They may be ok with a slightly lower dose. If symptomatic can go back up.

[GLORIAmunchkin72]

" If symptomatic can go back up."

Sometimes you cannot go back and when that happens it's very sad.

[Psychcns]

Why would you not be able to go back up

On the dose if pt symptomatic?

[comaok]

Having been "told" that my 60 bed "Dementia" unit was flagging high for Antipsychotic use in 2008, I fought tooth and nail (and thought I'd get fired at one point) the whole GDR idea. I sited most of the reasons you and other stated. When told it HAD to be done, I picked the worst residents with the most behaviors and met with my team. Honestly I assumed we'd try it and it would fail and I could say, "Yeah we tried it, you were wrong, now leave me alone."

Instead what we found was that by learning a lot more about the residents and their needs we were able to go from 33% to 2% in four years and the only residents still on antipsychotics, also have a diagnosis of Schizophrenia. Everyone with "Dementia with behavioral Disturbance" as a diagnosis was gradually reduced and eventually completely antipsychotic free.

It took a lot of work, a lot of tears and a lot of arguing and was not an easy road. It is in the end better for the residents and the staff and in most cases when we looked at the resident on the medication, they were still exhibiting the same behaviors we put them on the drugs for in the first place. The rational was - if they still have the behavior, the drug isn't working anyway. Along with a whole lot of other interventions and personalized care.

Not every story was a success, but for the most part my staff did great work and I have become a believer.

[CapeCodMermaid, RN]

I don't have any experience with this but that seems kinda weird. Those drugs are good for you. I would be watching for suicidal thoughts and symptoms.

No, Katie. Those drugs are NOT good for you, especially if you are an old person. If you are a psychotic old person, the drugs can certainly help and at times relieve horrible emotional pain, but on the whole, they are not good for you. We have found if we take the time to really get to know the resident, we can use far fewer drugs. PS. GDR is a federal regulation.

[bluegeegoo2, LPN]

On the flip side of GDR's, I absolutely loathe to see a new resident put on an antidepressant because he/she dared to voice feelings of sadness/loss at being placed in LTC and god forbid shed a tear. I have been witness to residents being put on pyschotropics because it is the anniversary of a loved ones death, their anniversary and their husband/wife is deceased, etc. They should all be allowed to feel without fear of being medicated. Obviously, if they remain sad/depressed and it doesn't appear it will self-terminate, then by all means. But I truly feel a pill should not be the first intervention placed for them.