(P23) Multidisciplinary Intervention to Reduce Antipsychotic Prescriptions at Skilled Nursing Facility

Objective/Aim: By March 1st, 2025, we aim to decrease the monthly number of antipsychotic medication (APM) prescriptions by 10% at a SNF. We planned two PDSA cycles focusing on pharmacologic and non-pharmacologic management of behavioral symptoms among residents. We used run charts to assess whether our interventions led to special cause variation in monthly number of APM.

Background: Nearly a fourth of individuals living in nursing homes in the US have received APM. Most were given for off-label indications and most often for individuals with dementia. There is evidence that APM can cause harm; however, robust data is lacking to support use of APM for behavior symptoms of dementia. Although non-pharmacological interventions are recommended as first-line for behavior issues, APM are perceived as an easier and more efficacious solution. This project took place at a SNF where an increased use of APM was noted.

Quality Improvement Methods: For baseline data, the total number of prescriptions for APM, antidepressants, anxiolytics, and sedatives/ hypnotics was obtained from January 2024-September 2024.

In the first PDSA cycle, the facility’s pharmacist provided an educational session in September to nursing staff addressing appropriate usage, side effects, risks, and monitoring of APM.

In the second PDSA cycle, nursing staff were surveyed in October to assess their perceptions and attitudes of APM. The survey assessed the perception of use of APM on a Likert scale of 1-5 ranging from very over utilized to very underutilized. It also assessed the use of non-pharmacologic interventions and barriers to their use.

We used the survey results to design an educational session for nursing staff on non-pharmacologic interventions for behavior symptoms which will be delivered to the nursing staff in November.

We will use a run chart to analyze APM prescription from January 2024- March 2025. Our balance measure is to assess monthly use of other psychotropic medications including antidepressants, anxiolytics and sedative/ hypnotics. We will use this data to assess whether there is special cause variation after educational interventions.

Results : Our baseline data from January to September 2024 shows that the average number of prescriptions per month is 20 for antipsychotics, 98 for antidepressants, 30 for anxiolytic, and 1 for sedative/ hypnotics. There was no significant special cause variation in the baseline data. Since the pharmacist intervention in September, we have not had sufficient time to analyze whether the intervention made a significant difference in APM prescribed. We plan to continue tracking the number of prescriptions over the next few months to assess whether our interventions have improved the outcome measure.

Conclusions: Our intervention to reduce APM prescriptions at a SNF showed that nursing staff is interested in learning more about both pharmacological and non-pharmacological management of difficult behaviors. The outcome data for our interventions on reducing antipsychotic usage is pending further data.