Psychotropic Medication Management

Psych360’s Psychotropic Care-Path™ was established to help our clients manage psychotropic medications in their facility. Through the implementation of CMS (Centers for Medicare & Medicaid Services) and ASCP (American Society of Consultant Pharmacists) recommended guidelines for psychotropic drug management, we focus on regulatory adherence for these psychotropic medications and quality of life for patients. There is an important balance to target and strike, and it’s important to have specialists familiar with these medications and their actions involved in this aspect of care.

With the initiation of the CMS Mega Rule, this mandates a monthly Drug Regimen Review (DRR) on each resident performed by the Pharmacist. Any recommendations regarding the patient’s drug regimen will need to be reviewed and addressed promptly. The new initiative has been expanded to encompass all psychotropic medications, not only anti-psychotics.

Any medication capable of affecting the mind, emotion, and behavior or medications that alter brain chemistry are considered psychotropic medications.

Classes of psychotropic medications include the following:

Our goal, in collaboration with our clients’ interdisciplinary team, is to reduce and/or limit pharmacological interventions. However, when they are necessary, a coordinated effort aligned with CMS and ASCP guidelines and state/federal regulations is the most appropriate and sound approach for both safety and optimizing a quality of life for the patient. 

Learn More About CMS Psychotropic Rules & Regulations

What is a psychotropic drug according to Centers for Medicare & Medicaid Services (CMS)?

The CMS considers any drug that affects brain activities associated with mental processes and behavior.

These drugs include, but are not limited to:

  • Antipsychotic
  • Antidepressant
  • Antianxiety
  • Hypnotic

What are the psychotropic drug guidelines?

Patients receiving medications receive gradual dose reductions (GDR), and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.

Within the first year in which a resident is admitted on psychotropic medication or after the prescribing practitioner has initiated a psychotropic medication:

  • The facility must attempt a GDR in two separate quarters (with at least one month between the attempts), unless clinically contraindicated.
  • After the first year, a GDR must be attempted annually, unless clinically contraindicated.

However, some residents with specific, enduring, progressive, or terminal conditions may need specific types of psychotropic medications or other medications, which affect brain activity indefinitely (i.e.: chronic depression, Parkinson’s disease psychosis, or recurrent seizures).

For an individual who is receiving a psychotropic medication to treat expressions or indications of distress related to dementia, GDR may be considered clinically contraindicated for reasons that include, but that are not limited to:

  • A 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 increase distressed behavior.

Diagnoses alone do not necessarily warrant the use of antipsychotic medication.

Appropriate indications for antipsychotics:

  • Schizophrenia (will not trigger on MDS)
  • Bipolar Mania
  • Huntington’s disease (will not trigger on MDS)
  • Tourette’s syndrome (will not trigger on MDS)
  • Delusional disorder
  • Depression with psychotic features
  • Psychosis NOS (in the absence of dementia)

Antipsychotic medications may be indicated if:

  • Behavioral symptoms present a danger to the resident or others.
  • Expressions or indications of distress that cause significant distress to the resident.
  • If not clinically contraindicated, multiple non-pharmacological approaches have been attempted but did not relieve the symptoms, which are presenting a danger or significant distress.
  • Gradual dose reduction (GDR) was attempted, but clinical symptoms returned.

If antipsychotic medications are prescribed, documentation must clearly show the indication for the antipsychotic medication, the multiple attempts to implement care-planned, non-pharmacological approaches, and ongoing evaluation of the effectiveness of these interventions.

What are the PRN rules?

Residents do not receive psychotropic drugs pursuant to a PRN order unless the medication is necessary to treat a diagnosed specific condition that is documented in the clinical record.

PRN orders for psychotropic drugs (except antipsychotics) are limited to 14 days, except if the attending practitioner or prescribing practitioner believes it is appropriate for the PRN order to be extended beyond 14 days. In this case, he or she should document their rationale in the resident’s medical record and indicate the duration for the PRN order.

PRN orders for antipsychotic drugs for 14 days cannot be renewed unless the attending practitioner or prescribing practitioner evaluates the resident (in person) for the appropriateness of that medication.

AP evaluation guidance:

  • Is the antipsychotic medication still needed on a PRN basis?
  • What is the benefit of the medication to the resident?
  • Have the resident’s expressions or indications of distress improved as a result of the PRN medication?

Psychotropic Medication Article Bank

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