The AHCA/NCAL Quality Initiative on Reducing Off-Label Use of Anti-Psychotic Medications

The American Health Care's (AHCA) quality initiative has set a goal to safely reduce the off-label use of these medications by 15% by the end of this year. AHCA suggests that facility staff ask the following critical questions when considering whether to initiate an antipsychotic drug or in re-evaluating the decision to initiate drug therapy:

  • What was done to try to figure out why the resident was doing (behavioral response)?
  • What might the resident be trying to communicate by doing (behavioral response)?
  • What is believed to be the reason for the resident doing (behavioral response)?
  • Unacceptable answers are "dementia" or "sun-downing"
  • What alternative approaches were tried before requesting medications?
  • Is there a physical reason for the behavior like untreated pain?
  • Is there an environmental reason for the behavior like over or under stimulation?
  • Could other medication side effects be the cause of the problem?

Encourage staff to look beyond behavior as a symptom of disease and to explore all possible things the person may be trying to communicate about an unmet physical, emotional, or psychosocial need. Find additional resources on how to safely reduce off-label use of antipsychotics on AHCA’s Quality Initiative website. Facilities that are already keeping the use of these drugs low, are asked to share their experiences. To learn more about CMS' changes to Five-Star and Nursing Home Compare, members can access a free archived webinar presented earlier this month. Additional help can be found through Five-Star's help line at 800.839.9290 through August 3rd.  Provider questions may also be addressed.

Be sure to save the date to attend VHCA’s September 12th program on reducing the use of anti-psychotic drugs in your facility.  Information on the program and registration will be available soon.