State Nursing Homes First in Reducing Antipsychotic Drugs

Nursing homes are using antipsychotics less and instead pursuing more person-centered care for residents with dementia, according to new data released on Nursing Home Compare in July by the Centers for Medicare & Medicaid Services (CMS). Nationally, use of antipsychotic medications in treating long-term nursing home residents dropped by more than 9 percent in the first quarter of 2013, compared with the last quarter of 2011. South Carolina facilities showed a drop of 16 percent, putting them at fifth highest in reduction of antipsychotic drug use. North Carolina nursing homes had the largest reduction of antipsychotic drug use with more than 23 percent.

Unnecessary antipsychotic drug use is a significant challenge in dementia care. The level of use in nursing homes has been a concern for decades. In 2012, CMS launched the National Partnership to Improve Dementia Care. The Partnership aims to reduce unnecessary antipsychotic medications in several ways. These include:

• Enhancing training for nursing home providers and state surveyors
• Increasing transparency by making antipsychotic use data available online at Nursing Home Compare
• Highlighting alternate strategies to improve dementia care

Today, there are approximately 30,000 fewer nursing home residents on these medications now than if the prevalence had remained at the pre-National Partnership level. The Partnership’s goal is to reduce antipsychotic drug usage by 15 percent by the end of 2013. Both North and South Carolina has already exceeded the national goal.

“Through a statewide effort, nursing homes have been provided with tools and resources for a person-centered approach that focuses on protecting residents by limiting antipsychotic medication use to those with a clinical indication,” said Theresa Seaberg, RHIT, CCS, CCME program manager for patient safety and care transitions. “Safety measures include implementing a systematic process to evaluate the needs of each individual and using non-pharmacological alternatives.”

The success in the Carolinas is in large part a result of the work of The Carolinas Center for Medical Excellence (CCME). Currently, South Carolina ranks seventh in the nation for the lowest use of unnecessary antipsychotic medications by long-stay residents.

CCME, the Medicare Quality Improvement Organization for North and South Carolina, and its partners—The South Carolina Health Care Association and The South Carolina Department of Health and Environmental Control—have worked collectively on a statewide effort to assist nursing homes by providing educational programs, tools, and resources focusing on a person-centered approach to reduce unnecessary antipsychotic medication use.

Patrick Conway, MD, MSc, CMS chief medical officer and director of the Center for Clinical Standards and Quality, said efforts to improve dementia care in nursing homes are yielding results. “We will continue to work with clinicians, caregivers, and communities to improve care and eliminate harm for people living with dementia,” he said.

For more information on the Partnership’s efforts to reduce use of antipsychotic drugs in nursing homes, please visit Advancing Excellence in America’s Nursing Homes.