I-Team In-Depth

Antipsychotic Use On The Decline In State Nursing Homes

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Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 33 percent since 2011 – a bigger decline than the national average — new government data show. The data released in June by the Centers for Medicare & Medicaid Services (CMS), show that nursing home residents in Connecticut, many with dementia, are still more likely to be given antipsychotics than their counterparts in 31 other states. But the state’s usage has fallen in the last 4 ½ years at a greater rate than the average drop of 27 percent, and it is now about the same as the national average — 17.4 percent. That’s down from 26 percent in 2011. CMS has been working with states for the past five years to address the overuse of antipsychotic medications in nursing homes.

Disparities

Antipsychotic Use Drops In State Nursing Homes, New Data Show

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Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 21.6 percent since 2011 – more than the national average — new government data show. The data, released Friday by the Centers for Medicare & Medicaid Services (CMS), show that nursing home residents in Connecticut – many with dementia — are still more likely to be given antipsychotics than their counterparts in 33 other states. But the state’s usage rate has declined more than the national average drop of 17.1 percent. “While quality improvement in the area of reducing off-label antipsychotic drug usage needs to be an ongoing effort, Connecticut’s skilled nursing facilities have achieved very positive change,” said Matt Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes. He said the state’s homes are making ongoing changes in “behavioral and health care practice” to further reduce reliance on antipsychotics.

I-Team In-Depth

Rate Of Antipsychotic Prescribing In Nursing Homes Drops

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Connecticut still ranks among the top 20 states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 14 percent since 2011, new government data shows. The percentage of patients receiving antipsychotics in the state’s nursing homes fell from 25.72 percent in early 2011 to 22.38 percent this year, according to new data from the Centers for Medicare & Medicaid Services (CMS). The state now ranks the 18th highest in the country in antipsychotic use – down from 16th highest in 2011, and no longer ranked among the top four states, as it was from 2005-10. Antipsychotic drugs are an important treatment for patients with certain mental health conditions, such as schizophrenia. But the Food and Drug Administration has warned that the drugs have potentially fatal side effects when used in elderly patients with dementia.

Fines & Sanctions

Connecticut Pilots Patient Safety Program For Nursing Homes

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In the 1970s, after investigators reported that more than 70 percent of air crashes involved human error, the aviation community worked with psychologists to develop a training protocol to improve teamwork, decision-making and safety. Since then, that core training has been adapted for use in other professions, including the military, firefighting and medicine. Now, health professionals in Connecticut have taken those basic lessons and drafted a training protocol for yet another high-risk setting: Nursing homes. The authors of the program, called TeamSTEPPS for Long-Term Care, say the simple training can save lives and money. They plan to pilot the program in Connecticut in the fall and promote it nationally.

I-Team In-Depth

State Nursing Homes Pilot Alarm-Free Initiative — Carefully

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When Florence Bolella, director of nursing at Kimberly Hall South nursing home in Windsor, told her staff to remove all the alarms from patients, fear and panic set in. Not among the residents, who were relieved to be free of the annoying beeps and squawks that sounded every time someone with mobility problems moved, but among the nurses’ aides. “The CNAs were so afraid they were going to get in trouble if a patient fell,” Bolella recalled. “It took us almost a year to remove 33 alarms. I eventually had to lock up the alarms, so the staff would stop using them.”

In the two years that the nursing home has stopped using both alarms and restraints, it has seen a decline in the number of falls. Bolella isn’t surprised: “I never felt the alarms were effective.”

Kimberly Hall South is among a handful of nursing homes in Connecticut that have gone “alarm-free,” meaning residents at risk of injury, usually from falls, are no longer outfitted with detectors on their mattresses, chair pads and clothing that emit a warning signal when they try to get up and move around.

Ann Spenard

High Use Of Antipsychotics In Nursing Homes Stirs Concerns, Reforms

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The Westside Care Center in Manchester is ranked among the best nursing homes in Connecticut, receiving a ‘five-star’ rating for overall quality under a federal rating system. At the same time, Westside has the state’s highest percentage of residents who receive antipsychotic drugs, even though they do not have a psychosis or related condition that regulators say warrants their use. Federal data shows 68 percent of Westside long-stay residents were receiving the drugs – more than double the state’s average of 26 percent, which already ranks in the top-third of states nationally. A C-HIT review of federal nursing home data from December found that Westside is not alone: High antipsychotic use, considered dangerous and unnecessary in many cases, does not impact quality ratings of nursing homes, and is often unknown to consumers selecting a home. In three-dozen Connecticut homes, at least a third of long-stay residents are on antipsychotics – yet nearly half of those homes have excellent overall ratings, of 4 to 5 stars.