west virginia success stories

WV Local Success Stories
Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. 

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Greenbrier Manor Reduces Antipsychotics and Increases Resident Safety

12/9/2016
Reducing the use of antipsychotic medication in long-term care facilities has been a focus across the nation for several years.  Greenbrier Manor, a long-term care facility in Lewisburg, WV and a member of the West Virginia Nursing Home Quality Care Collaborative, is one home that has met this challenge head on. 
 
During the national baseline timeframe (January 2013 through December 2013), Greenbrier Manor had a 21.14% antipsychotic rate.  The Interdisciplinary Team began reviewing and assessing all residents on antipsychotic medications in order to determine if their use was appropriate based on the most recent evidence-based data.  The team soon found that reducing the in-house antipsychotics was merely the first step in obtaining and maintaining the highest standard of care. They utilized their Quality Assurance Performance Improvement (QAPI) methodology to develop a system that would address admissions from the community if that resident’s plan of care included antipsychotics. 
 
The Medical Director, Dr. Doris Ragsdale, explains that any newly-admitted resident is assessed by the clinical team for any form of psychosis or psychotic symptoms that would suggest a psychotropic medication is appropriate.  This assessment involves a review of the diagnosis history that would indicate rationale for maintaining the medication for the present.  If no diagnosis history was present, the team would obtain a history and/or monitor the resident for the presence of any hallucinations, delusions, or other symptoms of potential psychiatric issues. 

Dr. Ragsdale states that this assessment could reveal a need for a psychiatric evaluation from other specialties.  If there is no indication of psychosis, then the medication begins a gradual dose reduction, individually tailored to that resident.  Dr. Ragsdale stresses the importance for the team to understand that when a GDR is occurring, failing that GDR is not as simple as the resident becoming combative, having an increase in restlessness or excessive crying, for example.  She states that many of these “behaviors” are how the resident communicates unmet needs.  As a team, they try to find the root cause of these communications from the resident and meet those needs.  Some examples of these unmet needs could be unrelieved pain, boredom, fear or untreated depression – and they must all be individually addressed with other treatments outside of antipsychotic medications. 
 
Dr. Ragsdale also stresses the importance of utilizing the Pharmacist Consultant when attempting to ensure quality resident care in relation to medications.  At Greenbrier Manor, the pharmacist will send Dr. Ragsdale a list quarterly of all residents on antipsychotic medications along with their diagnosis for that medication.  This quality control check ensures that no newly admitted resident slips through the cracks with GDRs missed or diagnosis incomplete.
 
Utilizing this QAPI format, the team at Greenbrier Manor is very proud of their January 2016 through August 2016 antipsychotic rate of 3.5%.  This rate continues to fall with the diligence of Dr. Ragsdale and her team.