Download Gradual Dose Reduction Guidance

F329 Unnecessary Drugs
Gradual Dose Reduction Guidelines
Effective May 24, 2013
Medication Class/Diagnoses
Guideline
Antipsychotics/Mood Stabilizers
used for the treatment of
dementia with associated
behaviors
Within the 1st year in which a
resident is admitted on an
antipsychotic medication or after
the facility has initiated an
antipsychotic medication, the
facility must attempt GDR in 2
consecutive quarters (with at least
one month in between) before
concluding that tapering is
“Clinically Contraindicated” for
that year. Must re-attempt
annually, unless clinically
contraindicated.
The acute treatment is LIMITED
TO 7 DAYS OR LESS. A clinician
in conjunction with the
interdisciplinary team must
evaluate and document the
situation within 7 days to identify
and address any contributing and
underlying cause of the acute
condition and verify the
continuing need for an
antipsychotic medication. If the
behaviors persist beyond the
emergency situation, pertinent
non-pharmacological
interventions must be attempted,
unless clinically contraindicated,
and documented following the
resolution of the acute psychiatric
event.
The facility must re-evaluate the
use of the antipsychotic
medication at the time of
admission and/or within two
weeks of admission (at the time
of the initial MDS assessment)
and consider whether or not the
medication can be reduced
(tapered) or discontinued
Attempt GDR in 2 consecutive
quarters (with at least one month
Antipsychotics initiated or used
to treat an emergency situation
such as acute onset or
exacerbation of symptoms or
immediate threat to health or
safety of resident or others
NEW ADMISSIONS: many
residents are admitted to a
SNF/NF already on an
antipsychotic medication
Antipsychotics/Mood Stabilizers
used for the treatment of
Clinically Contraindicated
Means
Most recent attempt resulted in
return or worsening of target
symptoms and physician has
documented rationale as to why
an attempt would likely impair
the resident’s function or cause
psychiatric instability.
Most recent attempt resulted in
return or worsening of target
symptoms and physician has
documented rationale as to why
an attempt would likely impair
the resident’s function or cause
psychiatric instability
Most recent attempt resulted in
return or worsening of target
symptoms and physician has
documented rationale as to why
an attempt would likely impair
the resident’s function or cause
psychiatric instability
Most recent attempt resulted in
return or worsening of target
Long Term Solutions Inc. • 935 S Lake Blvd • STE 6 • Mahopac, NY 10541
Phone 845 208 3328 • Fax: 845 628 7108
psychiatric disorders such as
schizophrenia, bipolar disorder,
psychotic disorder etc.
in between ) before concluding
that tapering is “Clinically
Contraindicated” for that year.
Must re-attempt annually, unless
clinically contraindicated
Psychopharmacologic
Medications
(any drug used to manage
behavior, stabilize mood, or treat
a psychiatric disorder)
Attempt GDR in 2 consecutive
quarters (with at least one month
in between ) before concluding
that tapering is “Clinically
Contraindicated” for that year.
Must re-attempt annually, unless
clinically contraindicated
Includes: Antidepressants,
anxiolytics. Does not include
cognitive enhancers
Sedative/Hypnotics
(Anything used for induction of
sleep)
Attempt GDR quarterly, unless
clinically contraindicated. Be
careful with hypnotics since
manufacturer guidelines
recommend taper in 14 days.
symptoms OR
Use of drug is in accordance with
relevant standards of practice and
the physician has documented
clinical rationale for why any
attempted dose reduction would
be likely to impair resident’s
function or cause psychiatric
instability.
Most recent attempt resulted in
return or worsening of target
symptoms OR
Use of drug is in accordance with
relevant standards of practice and
the physician has documented
clinical rationale for why any
attempted dose reduction would
be likely to impair resident’s
function or cause psychiatric
instability.
Most recent attempt resulted in
return or worsening of target
symptoms OR
Use of drug is in accordance with
relevant standards of practice and
the physician has documented
clinical rationale for why any
attempted dose reduction would
be likely to impair resident’s
function or cause psychiatric
instability.
Long Term Solutions Inc. • 935 S Lake Blvd • STE 6 • Mahopac, NY 10541
Phone 845 208 3328 • Fax: 845 628 7108