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.
The CMS considers any drug that affects brain activities associated with mental processes and behavior.
These drugs include, but are not limited to:
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:
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:
Diagnoses alone do not necessarily warrant the use of antipsychotic medication.
Appropriate indications for antipsychotics:
Antipsychotic medications may be indicated if:
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.
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:
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