Nursing Home Success Story: Lynn Care Center Reduces Use of Antipsychotic Medications

Warren Memorial Hospital Lynn Care of Front Royal, VA began their initiative to reduce antipsychotic use in June 2015. Their two social workers were charged with leading the initiative. The team included the Activities and Therapy Departments, unit managers, two certified nursing assistants (CNAs), two nurses who floated to all the different units, the director of nursing, the administrator and consultant pharmacist. Their medical director was unable to attend the meetings; however, the team shared meeting minutes and kept him updated on the entire process. His feedback and guidance were shared with the team at each meeting. The facility had open discussions with residents who were receiving antipsychotics and their families during care plan meetings.

This facility works very closely with Health Quality Innovators (HQI) by participating in regular quality measure review calls as well as reaching out to improvement consultants with questions and requests for resources. They use HQI’s composite score report on a regular basis during the Performance Improvement and QAPI meetings.

They started with a small group of residents and initiated gradual dose reductions to see what behaviors emerged for each individual resident. Next, they implemented the Five Why’s to determine the root cause of the behaviors. After determining the root cause, they implemented personalized interventions for each resident and shared this with all facility staff. Then, they used a combination of nurse’s notes and behavior documentation risk reports to track the behavior changes and adjusted their interventions as needed.

Throughout this initiative, staff, residents and family broke the old paradigm of “That’s how we have always done it.” Everyone sees how the residents’ quality of life has improved. The residents and their families feel like their lives now have more purpose and meaning. They can interact and be part of family and facility activities and events in more productive and meaningful ways. All their prescribers and staff are on board and supportive. Staff are more comfortable, engaged and initiate conversations with the prescribers when they notice changes in the residents.

They tracked their success through software reports and Certification and Survey Provider Enhanced Reports (CASPER) QM Reports, but said the most telling data that showed they were succeeding was HQI’s Composite Score Report. To sustain their achievement, they review their reports monthly and the committee meets quarterly.

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