Introduction
Avoiding the administration of unnecessary drugs is one of the primary concerns in long-term care facilities (LTCF). According to Quale (2016), “21.6% of facilities were cited for a F-329 deficiency” (para.2), signifying that the guidelines provided by the Centers for Medicare & Medicaid Services (CMS) are not followed. Such actions can be associated with increased costs and deterioration of patient outcomes. The present paper aims at reviewing gradual dose reduction (GDR) guidelines for LTCFs and summarizing its central points.
Definition
Before delving into detail about specific guidelines concerning tapering or GDR, it is worth giving a definition to the matter. According to CMS (2016), GDR is “the stepwise tapering of a dose to determine if symptoms, conditions, or risks can be managed by a lower dose” (p. 7). Additionally, GDR guidelines provide recommendations about when medications should be discontinued and when the procedure should be disregarded.
Main Points
Every medication is to be administered in appropriate doses for a relevant period to minimize the risk of adverse consequences. According to Simonson (2018), pharmacists have to make a drug regimen review (DRR) at least once a month to promote optimal drug therapy. Even though the procedure has been a requirement since 1974, CMS (2017) has made important clarification that DRRs should include resident’s medical chart reviews. During the DRRs, pharmacists should assess the effects of medications and decide if they are to be continued, reduced, discontinued, or modified in another way. The primary concern of the DDRs is seeking an opportunity to reduce the dose and duration to find an optimal admission regime. However, if a patient’s condition does not respond to a medication or deteriorate despite the treatment, the drug is to be discontinued or the dose altered, disregarding GDR (CMS, 2016). However, all irregularities are to be carefully documented and reviewed to avoid adverse effects. In short, pharmacists are required to evaluate medication admission regimes during DDRs or at any other opportunity to adhere to GDR.
Specific Recommendations
For antipsychotic medications, GDR should also be used unless clinically contraindicated. During the first year of a resident’s stay in an LTCF, GDR is to be attempted at least twice in different quarters with an interval of more than a month between the attempts (CMS, 2016). During the following year, GDR is instructed to be tried annually. GDR may be considered clinically contradicted if the resident’s target symptoms returned after an attempt to lower the dosage of a medication. Additionally, the procedure may be disregarded if a physician has indicated and documented a rationale for why further GDP attempts may impair a patient’s condition.
For sedatives/hypnotics, the tapering process is also recommended to minimize the possible adverse effects. The attempts are to be repeated quarterly unless clinically contraindicated (CMS, 2016). For psychopharmacological medications other than sedatives/hypnotics, the recommendations for tapering are similar to the GDR procedure concerning antipsychotics. Dose reduction is advised twice during the first year of administration in separate quarters with at least one month between the attempts and annually in the following years (CMS, 2016). The tapering process may be avoided if it causes condition deterioration or if a clinical rationale is documented by a physician. Overall, the recommendations for different medication groups are clear and specific.
Conclusion
GDR is crucial for providing quality care and reducing costs associated with drug administration. However, the recent changes in the procedure of psychotropic drug use in LTCFs add to paperwork, as treating enduring conditions requires thorough documentation in the resident’s medical record (Simonson, 2018). In conclusion, GDR encourages caregivers to use multiple non-pharmacological approaches to decrease medication administration and improve patient outcomes.
References
Centers for Medicare & Medicaid Services. (2016). State operations manual (SOM) surveyor guidance revisions related to psychosocial harm in nursing homes.Web.
Centers for Medicare & Medicaid Services. (2017).State Operations Manual.Web.
Quale, S. (2016). F-Tag in focus: F-329. McKnight’s Long Term Care News. Web.
Simonson, W. (2018). Significant changes in CMS pharmacy services F-Tags for long-term care facilities. Geriatric Nursing, 39(1), 112-114. Web.