The Centers for Medicare & Medicaid Services has updated survey guidelines regarding nursing homes’ use of antipsychotic medications for dementia care. The 59-page interim guidance revises Appendix P and Appendix PP of the State Operations Manual.
The Appendix P update includes new surveyor tasks to ensure that survey samples include enough residents who have dementia and who are taking an antipsychotic medication. Surveyors should request a list of residents who have been diagnosed with dementia and who are taking, have taken or have an as-needed prescription for an antipsychotic, the manual update says.
Updates to Appendix PP include new interpretive guidance related to care of residents with dementia, including medication use. For the first time, section F329 of this appendix names asenapine (Saphris), iloperidone (Fanapt), lurasidone (Latuda) and paliperidone (Invega) as atypical antipsychotics. F329 also defines when antipsychotics may be appropriately prescribed.
“Antipsychotic medications may be considered for elderly residents with dementia but only after medical, physical, functional, psychological, emotional psychiatric, social and environmental causes [of behaviors] have been identified and addressed,” the revised manual states. “Antipsychotic medications must be prescribed at the lowest possible dosage for the shortest period of time and are subject to gradual dose reduction and re-review.”
CMS is also releasing the third in a series of three mandatory surveyor training videos relating to antipsychotics and dementia. The video will be available after May 31. Click here for further information.
The complete manual update is available here.
The update and training video are meant to support the Partnership to Improve Dementia Care in Nursing Homes initiative, CMS said. The initiative, announced in March 2012, embraced the American Health Care Association’s call to reduce antipsychotic prescribing in nursing homes 15% by the end of 2012. Providers fell short of that goal, AHCA recently announced, but the group renewed the 15% reduction goal for 2013.
