Results
A total of 67 patients on psychotropic medication on the CLC wards since January 2014 were included in the program. Before implementation of the program, 35 patients had documentation of psychotropic medication review. Following implementation, this increased to 54 patients. Hence, 80% of the patients had appropriate documentation.
Before implementation, no patients had documentation regarding evaluation of a GDR in CPRS. After the program implementation, 54 patients had documentation of GDR. Of the 54 patients, 50 had documentation that a GDR could not be completed, and 4 patients had undergone a trial of GDR with appropriate documentation in CPRS (Figure).
The secondary objective evaluated how often a review of patient’s psychotropic medication occurred during IDT meetings. During March 2014, 21 patients with scheduled IDT meetings were prescribed psychotropic medications. For 14 of the 21 patients (67%) appropriateness of psychotropic medications was reviewed with the team and the resident’s families.
Discussion
Documentation is fundamental to improving quality of care, patient outcomes, and reimbursement for the facility. Effective since July 1, 2014, the Joint Commission standards for Nursing Care Center accreditation require the physician and consulting pharmacist to review the patients’ or residents’ medication list. The review should verify the following:
- Clinical indication for the antipsychotic medication;
- Necessity for ongoing use of the antipsychotic medication;
- Consideration of GDR of the antipsychotic medication;
- Consideration of an alternative to antipsychotic medication use.8
When used correctly, the psychotropic medication review and GDR template ensures veterans’ psychotropic medications are continually reviewed. Furthermore, better psychotropic medication management allows veterans to be adequately treated while minimizing the risk for potential AEs.
At CVVAMC, the electronic template helped improve documentation and evaluation of GDR. The CVVAMC success can be attributed partly to physicians who were willing to use the template.
New standards from the Joint Commission provided an additional incentive to use the template. The Joint Commission also required that patients and their family be involved in decisions about placing the resident on antipsychotic medication. The optimal time for this discussion is during IDT meetings. At CVVAMC, discussion of psychotropic medications took place in IDT meetings for 67% of the patients prescribed psychotropic medication.
It is important to note that tools, such as this template, are successful only if they are used by HCPs. The CPRS does not have any clinical reminders to prompt physicians to complete the task. Instead, HCPs had to develop a routine of entering information into the template. Additionally, if the resident assessment coordinator was not at the IDT meeting, discussion of psychotropic medication was not always completed. After completion of this project, psychotropic medication review has become a permanent component of the IDT care plan.
Conclusion
This project demonstrated that template development and use have the potential to improve documentation, patient care, and survey scores. The electronic template could potentially benefit any long-term care facility that uses an electronic recording system. Further research should focus on ease of use and on ensuring that a psychotropic medication review is added to all CLC IDT care plans.
Acknowledgments
The authors acknowledge Brooke Butler, clinical pharmacy specialist and project mentor for her assistance and guidance; and Deborah Hobbs, residency director, both at the Carl Vinson VA Medical Center for her input and leadership, and Freddie Miles, for her work on development of the electronic order set.