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Minimizing the Use of Antipsychotics in Long-Term Care

presented by Elizabeth Galik

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Disclosure Statement:

Financial: Elizabeth Galik receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Elizabeth Galik has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Accreditation Check:
Antipsychotic medications have been widely used to manage behavioral symptoms among older adults with dementia. The Centers for Medicare and Medicaid have launched a policy initiative to decrease the inappropriate use of antipsychotics in long-term care settings due to minimal effectiveness and risks associated with their use. Antipsychotic use now affects nursing homes’ five-star quality rating score. This session will describe the appropriate use of antipsychotics and help nurses to monitor for potential side effects of these medications. Additionally, common challenges and practical solutions for antipsychotic reduction in long-term care settings will be discussed.

Meet Your Instructor

Elizabeth Galik, PhD, CRNP, FAAN, FAANP

Elizabeth Galik is a Professor at the University of Maryland School of Nursing. She received a BSN from the University of Pennsylvania, an MSN from Villanova University, a post-master's Adult Nurse Practitioner Certificate from Johns Hopkins University, and a PhD from the University of Maryland. Her research interest is in developing and testing interventions to…

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Chapters & Learning Objectives

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1. Use of Antipsychotics

This chapter will describe the prevalence of antipsychotic use among older adults. Additionally, approved uses of antipsychotics per the Food and Drug Administration (FDA) will be reviewed as well as off-label uses. This is important because the prevalence of antipsychotic use is moderate among older adults in long-term care settings, and most antipsychotics are prescribed for off-label uses.

2. Effectiveness and Risks Associated with Antipsychotics

This chapter will describe the potential benefits and risks associated with antipsychotic use among older adults, particularly those individuals with dementia. Antipsychotics have evidence of efficacy when used to treat schizophrenia and bipolar disorder and may have limited efficacy when used for psychotic symptoms and physically aggressive symptoms in the context of dementia.There are numerous potential side effects associated with antipsychotics that may negatively impact health and function, including increased risk of death among older adults with dementia.

3. Potential Challenges Associated with the Gradual Dose Reduction of Antipsychotics in Long-Term Care Settings

This chapter will describe the potential challenges and practical solutions associated with the gradual dose reduction of antipsychotics in long-term care settings. Potential challenges that will be discussed include: silo approach to care, misunderstanding of the Centers for Medicare and Medicaid regulation regarding the use of antipsychotics, unfamiliarity with assessment tools to monitor antipsychotic use, and gradual dose reduction of antipsychotics. It is done without emphasis on the use of nonpharmacological approaches to management of behavioral symptoms.

4. A Step-based Approach to Reducing the Inappropriate Use of Antipsychotics

This chapter will discuss a five-step approach for successfully reducing the inappropriate use of antipsychotics in the long-term care setting. This five-step approach can be utilized in any long-term care setting and will help your facility remain in compliance with the Centers for Medicare and Medicaid regulation, F-Tag 329.

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