Choosing Wisely – 15 things we should question
Phase 3 guidance: GDR regulations
· Non-traditional meds such as antihistamines, seizure meds, other CNS meds, when use appears to be a substitute for a traditional psychotropic are now subject to GDR guidelines
· Attempt GDR: Twice within the first year, in two separate quarters, at least one month apart. After the first year, reductions must be attempted annually
· GDRs should be done in a manner than minimizes withdrawal with appropriate tapers.
o Dose changes may take 4-6 weeks to see full effect. Be careful not to classify a failure 3 days into an attempted GDR.
· CMS surveyors will look for the potential of psychosocial harm by interviewing staff and/or resident to determine if side effects have adversely affected the resident’s QOL
o Renewal requires a new prescription AND a direct evaluation of the patient by the prescriber
o Prescriber must document a specific rationale for therapy, specific benefits to patient, and progress to goals of therapy.
· Antipsychotics –absolute hard stop on PRN antipsychotics at 14 days. No exceptions.
· Other psychotropics – limited to 14 days unless:
o Prescriber documents specific diagnosis, treatment benefits, rationale for extending beyond 14 days AND a specific duration of treatment
o includes antihistamines such as hydroxyzine when uses for behaviors
· Compazine is an antipsychotic
· Hospice is NOT EXEMPT from PRN rules or any rules.
· Documentation should include an indication with an identified clinical rationale that is based upon an assessment of the resident’s condition and therapeutic goals