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P008: Division of Health Improvement/Health Certification Licensing and Oversight

P008: Percentage of long-stay nursing home residents receiving psychoactive drugs without evidence of psychotic or related condition

Current Value

15.9%

2017

Definition

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Story Behind the Curve

  • Nationally, over half of nursing home residents have some form of dementia, and many experience related behavioral and psychological symptoms. The U.S. Centers for Medicare and Medicaid Services (CMS) National Dementia Partnership to Improve Dementia Care in Nursing Homes recently announced it has met its goal of 30% reduction by 2016 of anti-psychotic medication for nursing home residents without a valid clinical reason or evaluation. 
  • Antipsychotic medication may contribute to falls, withdrawal, and other behaviors that harm a resident’s health or quality of life. Therefore, it is important we work toward eliminating use of these psychoactive drugs among New Mexican patients who don't have evidence of psychotic or related conditions.
  • From CMS data for 2017, New Mexico ranks 32 of all states with a prevalence of 15.9%. The national prevalence rate for 2017 is 15.1%
  • Information is tracked through the Minimum Data Set (MDS). The Division of Health Improvement (DHI) is working toward better and more accurate use of the MDS records in nursing homes. There is a two-quarter lag in reporting data. Since the beginning of the national initiative, New Mexico has demonstrated a change from 21.7% to 15.9% (CMS Dementia Partnership data).
  • By sharing best practices and monitoring MDS data during the survey process, DHI can further eliminate use of antipsychotic medication and improve quality of life for nursing home residents. Surveyors investigate onsite to ensure residents receive antipsychotic medication when medically indicated and use of antipsychotic medication is appropriately monitored during annual surveys.
  • This measure is explanatory.

Partners

  • Nursing Home Facilities
  • New Mexico Health Care Association
  • HealthInsight
  • CMS

What Works

  • In March 2012, CMS launched a nursing facility quality initiative that included a goal to decrease the off-label use of antipsychotics by 15% by December 2012. Since then, other organizations, including the American Society of Consultant Pharmacists (ASCP), have joined the effort to provide guidance on appropriate antipsychotic prescribing in nursing facilities.
  • DHI works with the New Mexico Health Care Association and nursing homes to share data and trends, and provide training and information regarding the CMS quality initiative.
  • HealthInsight coordinates the State Dementia Partnership in providing behavior management training to direct care staff to reduce acting out behaviors and lessen the need for medication to manage behavior. 
  • Increase public awareness of the importance of reducing the use of antipsychotics. 
  • Public reporting of nursing home data on the use of antipsychotics.
  • CMS training for surveyors who inspect nursing homes.
  • Cited deficiencies assist in the reduction of unnecessary anti-psychotic medication use. 

Strategy

  • DHI partners with the New Mexico Health Care Association and nursing homes to share data and trends, and provide training and information regarding the CMS quality initiative.
  • HealthInsight coordinates the State Dementia Partnership in providing behavior management training to direct care staff to reduce acting out behaviors and lessen the need for medication to manage behavior. 

Action Plan

  • Q1:
    • Long-Term Care (LTC) surveyors continue to enforce regulations related to use of unnecessary medications including the use of antipsychotic medications without an appropriate clinical diagnosis during the recertification nursing home annual surveys. Completed.
    • MDS coordinator will educate surveyors of statewide dementia partnership initiatives and provided ongoing training opportunities. Completed
  • Q2:
    • This is a current CMS/HealthInsight performance measure. DHI will continue to meet quarterly with the HealthInsight team and state dementia partnership to develop strategies to engage providers and nursing homes statewide to decrease anti-psychotic drug use.
    • MDS coordinator, who is a registered nurse, will meet with the HeathInsight team to establish a plan to assist in the accurate reporting of nursing home data.
    • Long-Term Care (LTC) surveyors continue to enforce regulations related to use of unnecessary medications including the use of antipsychotic medications without an appropriate clinical diagnosis during the recertification nursing home annual surveys
    • HealthInsight has begun providing behavior management training to direct care staff to reduce acting out behaviors, thereby reducing the need for medication to manage behavior.
  • Q3:
    • MDS coordinator will send out a statewide email to provide guidance on accurate data reporting and ideas on ways to reduce antipsychotic drug use. 
    • MDS coordinator will meet with HealthInsight team in and provide a training for providers regarding MDS coding to ensure accurate reporting of antipsychotic use in nursing homes.
  • Q4:
    • MDS coordinator will educate surveyors of statewide dementia partnership initiatives and provided ongoing training opportunities. 
    • MDS coordinator will schedule dementia partnership facility specific data and regulatory updates training for surveyors. 

FY18 Annual Progress Summary

  • In FY17 DHI was successful in partnering with trade organizations to meet and provide trends data and best practices to health facilities on this national initiative to reduce the use of antipsychotic medications in nursing homes. During FY17 there was a small decrease in the percent of use. DHI will work and partner with trade organizations and other areas of DOH in continuing quality improvement actions for FY19. 
  • DHI was successful in recruiting a new Minimum Data Set coordinator.

FY19 Annual Progress Summary

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