need clarification regarding GDR documentation

[glm777, BSN, RN]

"In N0450B and N0450C, include GDR attempts conducted since the resident was admitted to the facility"

Back to original admission date or most recent re-entry date?

Also, our pharmacy puts a note in the chart documenting that a GDR is due. They include in the note a paragraph that states "a GDR attempt is likely to impair this individual's function or cause psychiatric instability by exacerbating an underlying medical condition or psychiatric disorder AS DOCUMENTED BELOW"

On the line below, our MDs/psych service usually document :

needs meds for stability.

needs for schizophrenia.

needs for yelling/agitation.

Is this adequate for GDR contraindication documentation? Can this be considered a true "risk vs. benefit" statement?

I have read and re-read the RAI manual multiple times.

In your opinion, would you code that statement, as documented above, as a "yes" in section N 0450D - "Physician documented GDR as clinically contraindicated" ?

I appreciate everyone's opinion!

[glm777, BSN, RN]

Another thought: If the resident had a GDR say on 10/31/19, but had a risk vs. benefit note stating a reduction in med was contraindicated on 3/31/19, do you still code "Yes" for N0450D?

[Talino]

Yes, they are valid MD documentation.

APPENDIX PP pp 523-524

For any individual who is receiving a psychotropic medication to treat a disorder other than expressions or indications of distress related to dementia (for example, schizophrenia, bipolar mania, depression with psychotic features, or another medical condition, other than dementia, which may cause psychosis), the GDR may be considered clinically contraindicated for reasons that include, but that are not limited to:

•The continued use is in accordance with relevant current standards of practice and the physician has documented the clinical rationale for why any attempted dose reduction would be likely to impair the resident’s function or exacerbate an underlying medical or psychiatric disorder; or

•The resident’s target symptoms returned or worsened after the most recent attempt at a GDR within the facility and the physician has documented the clinical rationale for why any additional attempted dose reduction at that time would be likely to impair the resident’s function or exacerbate an underlying medical or psychiatric disorder.