Implementing Psychopharmacology Rounds in a Nursing Facility to Improve Antipsychotic Usage.

OBJECTIVES

Evaluate whether implementing of pharmacy-led psychopharmacology rounds in a nursing facility will improve the rate of antipsychotic use.

DESIGN

Single-center, prospective; medication use evaluation (MUE).

SETTING

Rutland Nursing Home, Brooklyn, New York.

PARTICIPANTS

Nursing facility residents, excluding the pediatric unit.

INTERVENTIONS

Weekly interdisciplinary psychopharmacology rounds that include: clinical pharmacists, nurse managers, medical director, social workers, and administration. Antipsychotics were analyzed for all residents for appropriateness of use, proper documentation, and adequate monitoring.

MAIN OUTCOME MEASURE

Assess the overall rate of reduction of antipsychotic use after implementation of psychopharmacology rounds. Secondary outcomes assessed improvements in monitoring and documentation for residents on antipsychotics.

RESULTS

A total of 81 residents were evaluated over the six-month MUE. Of those residents, 20 had their antipsychotics discontinued, and 11 had their antipsychotics tapered. The overall use of antipsychotics decreased from 14.6% (62/422) to 12.2% (50/411) (P = 0.285). Compliance with indications generally approved by the Centers for Medicare & Medicaid Services improved from 65% (37/57) to 85% (46/54) (P = 0.008). Matching indications on the psychiatry consult and the medication order improved from 58% (33/57) to 80% (43/54) (P = 0.015). Metabolic laboratory monitoring improved from 58% (33/57) to 83% (45/54) (P = 0.003). Improvements in timeliness of psychiatry and ophthalmology consults were not statistically significant.

CONCLUSION

Implementing interdisciplinary psycho-pharmacology rounds in a nursing facility resulted in a reduction of inappropriate antipsychotic use and improved monitoring and documentation.