In Rhode Island, the New England QIN-QIO Nursing Home Team convened staff from local nursing facilities who were struggling to reduce antipsychotic medication use among their resident population. During this meeting, held in January 2017, the QIN-QIO team incorporated input and participation in collaboration with the New England QIN-QIO Quality Improvement Initiative Lead, to offer technical support to attendees in an effort to help the challenged facilities to reduce their antipsychotic rate.
The meeting drew nursing staff from 24 Rhode Island nursing facilities; 11 requested the additional technical assistance. From the facilities requesting support, both the QIN-QIO Nursing Home Team and Quality Improvement Lead reviewed facility data and prioritized the requests, focusing attention first on facilities with the highest rates. The QIN-QIO Quality Improvement Lead and the Nursing Home Team met individually with the facility nursing staff struggling and provided a toolkit suggesting non-pharmacological and patient-centered approaches, as well as a tool to help assess medication necessity.
As a result of the collaboration between the QIN-QIO Nursing Home Team, the Quality Improvement Initiative Lead, and the individualized technical support, two nursing facilities with extremely high antipsychotic rates were able to dramatically reduce rates in only two months.
Nursing staff at one of the facilities implemented a new process with the help of their Medical Director that involved immediately assessing residents upon admission. This new process was incorporated into their Quality Assurance and Performance Improvement (QAPI) program in an effort to make the process sustainable. Within two months, the facility was able to reduce their antipsychotic medication rate from 31% to 16%, falling within the national average. While some residents in this facility are still on antipsychotic medications, 10% are in gradual dose reduction and are “weaning” which shows hope for an even further rate reduction in the near future.
Another facility that has noted success due to QIN-QIO technical assistance originally had 40% of their resident population on antipsychotics. The facility’s nursing team and the QIN-QIO performed a route cause analysis and found they were admitting a lot of younger residents with PTSD. Realizing that many of these residents will likely never come off the medication, the nursing team focused on the residents who had no behavior issues and a diagnosis of dementia. Using this focused approach, the facility decreased their antipsychotic rate from 40% to 38% within two weeks. Additionally, the route cause analysis revealed barriers among other interdisciplinary team members. For example, staff from social services was pushing back on plans for reducing medications, feeling that this new approach would not benefit those residents with behavioral problems. To offset this barrier, the QIN-QIO provided the facility’s nursing team with resources and articles on best practices and standards of care to educate non-nursing staff. The nursing team is currently working to educate all staff members to bring them on board to support the process.
The successful collaboration between the QIN-QIO Nursing Home Team and the Quality Improvement Lead offers a value-added approach to help nursing facilities in Rhode Island reduce antipsychotic medication use. Through this quality improvement process, the QIN-QIO offers one-to-one assistance (to facilities that request additional support) and works with facility staff to track data and monitor improvement and/or reassess the progress, as necessary. The QIN-QIO is working to provide help to the remaining facilities requesting technical assistance with the hope of making a significant impact to reduce antipsychotic medication use across the state of Rhode Island.