Long-Term Care Survey Alert

True or False? To avoid a citation at F329 (unnecessary drugs), the facility must show the interdisciplinary staff has tried environmental or interpersonal strategies before resorting to antipsychotic medications.

The State Operations Manual doesn't say a facility has to use environmental modifications and interpersonal interventions to address residents' dementia-related behaviors before starting psychoactive medications, says Tom Clark, RPh, MHS, director of policy and advocacy with the American Society of Consultant Pharmacists.

"But the Centers for Medicare & Medicaid Services has always recommended that facilities start with nonpharmacological approaches, where possible," says Clark. "And if medication is necessary, start with a low dose and titrate it to an effective dose."

There are clear-cut situations where you'd use psychoactive medications first in an acute situation where a person presents a danger to himself or others, Clark adds.

Editor's Note: For more information on avoiding F329-F331 tags for antipsychotic use (and CMS' revised survey guidance for these tags), see the December 2004 Long-Term Care Survey Alert. Subscribers can log onto the online subscription service at www.elihealthcare.com. If you haven't signed up for this free service, call 1-800-874-9180.