Reducing Antipsychotic Use: Best Practices for Nursing Homes

The use of antipsychotic medications in nursing homes has been a long-standing issue, particularly for residents with dementia-related behaviors. While these medications may sometimes be necessary, overuse can lead to serious health risks, including falls, sedation, cardiovascular events, and increased mortality.

The Centers for Medicare & Medicaid Services (CMS) has prioritized reducing inappropriate antipsychotic use in long-term care facilities, and nursing home consultants like Qsource provide guidance and support to help nursing homes implement safer, person-centered alternatives.

Why Reducing Antipsychotic Use is Critical

Antipsychotics are often prescribed to manage agitation, aggression, and hallucinationsin residents with dementia. However, these medications do not treat dementia itself and come with significant risks, including:

• Increased risk of stroke and heart attack
• Higher mortality rates in elderly populations
• Severe sedation leading to falls and fractures
• Worsening cognitive decline

CMS and healthcare organizations have strongly encouraged nursing homes to seek alternative approaches before resorting to medication.

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Best Practices for Reducing Antipsychotic Use

Conduct a Root Cause Analysis of Behavioral Symptoms

Before prescribing medication, it is essential to understand the cause of a resident’s behavior. Many behavioral symptoms can be linked to unmet needs.

Prioritize Non-Pharmacological Interventions

Non-drug approaches should be the first line of defense in managing behavioral symptoms.

Best Practice: Create an individualized behavior management plan for each resident that outlines non-drug interventions before considering medication.

Implement Gradual Dose Reductions (GDRs)

CMS requires nursing homes to attempt Gradual Dose Reduction (GDR) for residents on antipsychotic medications unless clinically contraindicated.

Best Practice: Establish interdisciplinary review meetings to assess GDR efforts and track resident progress.

Train Staff on Behavior Management Techniques

Frontline staff play a critical role in preventing unnecessary antipsychotic use. Providing comprehensive training on behavioral management can significantly reduce reliance on medication.

Key Staff Training Topics:

• Understanding Dementia-Related Behaviors – Teaching staff how to recognize and respond to behavioral changes.
• De-Escalation Techniques – Strategies for redirecting aggression and agitation.
• Effective Communication Skills – Using calm, reassuring language to soothe distressed residents.
• Recognizing Nonverbal Cues – Identifying discomfort, pain, or anxiety before behaviors escalate.

Best Practice: Implement Annual and as needed training, when concerns arise from audits on non-pharmacological interventions to ensure ongoing competency.

Involve Families in Care Planning

Families often request antipsychotics out of concern for a loved one’s distress. However, educating families on the risks and alternative treatments can foster a collaborative approach to care.

Family Engagement Strategies:

• Hold family meetings to discuss medication risks and alternative treatments.
• Provide educational materials on dementia care best practices.
• Encourage families to participate in activities that engage their loved ones.

Best Practice: Use Qsource resources to educate families on safer approaches to managing behaviors in dementia care.

Strengthen Collaboration with Physicians and Pharmacists

Physicians play a key role in prescribing antipsychotics, while pharmacists ensure medication safety and compliance. Close collaboration between these professionals and nursing staff can help reduce inappropriate prescribing.

Best Practice: Work with Qsource’s expert consultants to streamline medication management protocols and ensure compliance.

Monitor and Track Progress on Antipsychotic Reduction

Measuring progress is essential for sustaining long-term reductions in antipsychotic use. Facilities should track key data points.

How to Track Progress Effectively:

• Use Electronic Health Records (EHRs) to document behavior interventions.
• Assign a designated team member to oversee antipsychotic reduction initiatives.
• Conduct mock surveys to identify potential compliance risks before CMS inspections.

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Qsource’s Role in Reducing Antipsychotic Use

Qsource, Skilled- Nursing Facility Consultants, helps nursing homes:

• Implement best practices for reducing unnecessary medications
• Train staff on non-pharmacological dementia care strategies
• Conduct medication audits and compliance checks
• Improve Five-Star Quality Ratings through targeted interventions

 Reducing antipsychotic use in nursing homes requires a commitment to person-centered care, staff training, and collaboration with healthcare professionals. By prioritizing non-drug interventions and regulatory compliance, facilities can enhance resident well-being and survey readiness while minimizing risks.