MDS Alert

Determine the resident’s ‘true needs’ before starting psychotropic meds.

Are you conducting a thorough enough assessment before starting residents on psychotropic medications? If you’re not asking these nine questions, your assessment may not pass muster when it comes to proper compliance.

"A good assessment prior to starting a psychotropic medication can be defined in part by the provider ensuring that he or she is conducting a thorough evaluation that will identify what the resident’s true needs are," Dr. Susan Levy, vice president of medical affairs at the Levindale Hebrew Geriatric Center & Hospital said in a recent Centers for Medicare & Medicaid Services (CMS) surveyor training webcast.

Levy recommended that, for each individual resident, you should ask the following questions:

1. What goal do I anticipate to accomplish through the use of the psychotropic medication?

2. Is there a supporting diagnosis?

3. What is it that the resident is trying to communicate? Is the resident perhaps trying to communicate any unmet needs?

4. Is the resident experiencing some type of delirium, or is it a form of dementia — and if so, what type and what is the cause?

5. Are there environmental stressors that are contributing, and what can be done to change or reduce those?

6. Are complications arising from internal or external stressors?

7. Is the resident possibly having a response to medications that he is already receiving?

8. What happens before, during and after the resident’s behavior?

Lesson learned: "This is where it becomes key to know the person," Levy said. "Investigating and attempting various non-pharmacologic approaches and interventions may reduce the need for any psychopharmacological medication and can be the fundamental first step."