psychotropics

[katoline]

I have a question. Even though I've been doing this for a while, each facility does things differently. Is there a CMS rule for this?

i realize that a medication is what it is, no matter the purpose. That said, depekote for mood stabilization is not counted as a antipsychotic or antidepressant. Likewise trazadone if used prn (some docs still use it that way) at HS for sleep is still an antidepressant not a sedative. How do you careplan these? Do you have to do quarterly ancillary assessments? if so, how is that handled? i've seen in the chart where family consent is obtained for meds like depekote and klonopin. I understand where behavior sheets are needed if that is their purpose, but do you handle the medication and the purpose seperately? a mood/behavior careplan, but not a psychotropic?

[SuesquatchRN, BSN, RN]

We care planned meds as that for which they were used - if it was depakote for behaviors we care planned for behaviors and as a psych. It it was trazadone for sleep it was care planned as a psych and treated as a hyponotic as that is more its effect. It was updated quarterly per CMS and we did an in-house psych med sheet on each. It's also a good time to do the AIMS if its a med prone towards causing PS or TD, and to remember to check any lab levels needed as for Depakote.

[katoline]

Thanks! What about consent forms?

I've only been doing AIMS on antipsychotics since side effects for antidepressants and antianxiety meds don't include PS or TD. The same for anticonvulscants. I have recently been adding medication toxicity careplans on many of these meds since our pharmacist recommended for Black Box Warnings.

[PsychNurseWannaBe, BSN, RN]

We get our consent forms from the DQA website. I was told that we have to care plan according to the class of medication. Trazadone = antidepressent. If we get it for insomnia, the MD is immediately contacted with a request to change the medication... for example melatonin.

[katoline]

:)PNWB, what is the DQA website?

I feel that the reason for the medication should be careplanned as well as the medication itself. I think there should be behavior sheets on the MAR if appropriate as well. What i am confused about is our quarterly ancillary assessments.

Klonopin and depakote aren't psychotropics, probably should still be monitored as any potentially harmful drug if potential for toxicity, but labs levels may be different for psych purposes than for seizures, at least that's what a psychiatrist told me. Maybe i should ask our geriatric pharmacist that comes in. thanks for all the input

[SuesquatchRN, BSN, RN]

Isn't Klonopin a tranq? And Depakote isn't included on the MDS as a psych me but care planned as such.

[katoline]

no, klonopin is one of those meds like depakote that's used for mood/behavior. it's an antiseizure medication. sounds like a sedative or antianxiety because clonazepam (it's generic name) sounds like lorazepam (ativan) they are both benzodiazepines.

what the heck's the difference? i don't know. reading the drug book now and ativan is used for status epilepticus like valium is. must be some cross over. side effects of one useful for something else. i've given and taken a lot of meds over the years, i remember the ones i personally muddled thru the most.

[katoline]

we have a medication toxicity careplan. i think maybe meds like depakote, klonopin should be careplanned there. it covers dig, coumadin, lasix some others. then have a seperate behavior careplan.

[SuesquatchRN, BSN, RN]

we have a medication toxicity careplan. i think maybe meds like depakote, klonopin should be careplanned there. it covers dig, coumadin, lasix some others. then have a seperate behavior careplan.

Depakote isn't a big one for toxicity but you want to be sure it's at a therapeutic level for behaviors, which is a much lower level than seixure prevention.

The meds should definitely be in the behaviors care plan and, to be safe fromNYS, at least, in the psych section as well.

[PsychNurseWannaBe, BSN, RN]

For the state of Wisconsin, antipsychotics, antidepressents, hypnotics, benzodiazepines are considered psychotropic meds and must be monitored including attempts for gradual dose reduction and consents must be obtained. Even if valium is used for leg spasms for a MS patient, a consent must be obtained. I don't believe it will be followed by a gradual dose reduction program d/t a "medical" necessity and not a "psych" one. For us, we also obtain consent for depakote among other medications.

The BQA (old department name) is the department that oversees nursing homes in Wisconsin. Their website have all the consents that can be printed but they have the State of Wisconsin stuff on it.

http://www.dhs.wisconsin.gov/forms1/F2/MedBrandName.htm

[SuesquatchRN, BSN, RN]

The GDR (gradual dose reduction) can be tried once and if it doesn't work documented up the yin yang. MDs can also write justifications for not attempting. You can also reduce by a very small amount.

Consents were not required in NYS.