Gradual Dose Reduction Program

We’re committed to evaluating the use of psychotropic drugs in an effort to ensure their proper utilization with residents of a nursing care facility.

The goal of our gradual dose reduction program is to ensure:

The use of psychotropic drugs is based upon an appropriate differential diagnosis of current behavioral symptoms.
Potential causes of the behavioral symptoms from environmental, psychosocial, and medical factors have been considered and ruled-out or otherwise identified and addressed through appropriate forms of intervention.
Each resident's psychotropic drug regimen is free from unnecessary drugs, including drugs prescribed in excessive dosages, for excessive durations, without adequate monitoring and indications for use, or in the presence of adverse consequences.

Our Policy Objective: All residents who are currently receiving a psychotropic drug will be evaluated to determine and document (via Behavioral Care Solutions' standardized GDR record forms) the necessity of the drug.

1. All current residents receiving psychotropic medications and those classes indicated under OBRA F-329 and F-330 should be evaluated by BCS psychiatric clinicians.

2. Once evaluated, each resident will continue to be re-evaluated at appropriate intervals or minimally on a quarterly basis.

3. All residents being treated with a psychotropic drug at the time of their admission should be evaluated by BCS psychiatric clinicians for unnecessary drug usage as part of the initial care plan.

Our Suggested Procedure: A Gradual Dosage Reduction Assessment should be completed upon admission or initiation of a psychotropic drug and minimally, every quarter thereafter. BCS psychiatric clinicians should evaluate each resident receiving a psychotropic medication.

This evaluation will include:

1. A determination of the necessity for psychotropic medication.

2. A determination of the appropriateness of each particular drug as to dose and duration of usage, with clear indications of the behavioral symptomatology that supports its use.

3. Consideration of a possible decrease in the dosage of the medication, discontinuation of the drug, or change to a necessary drug with minimal or fewer side effects.

4. A determination of the need for referral to the assigned Behavioral Care Solutions psychologist for development or alternative non-pharmacological based behavioral and/or supportive interventions to assist in amelioration of symptoms.

5. Documention of the the actions taken and supportive rationale in the BCS standardized diagnostic evaluation report form and specialized GDR record form.

If behavioral or supportive services were initiated by a Behavioral Care Solutions‘ psychologist or social worker, then a behavioral or supportive treatment plan will be generated and a hands-on “mini in-service" will be provided to unit staff that focuses on effective implementation of the behavioral or supportive program. Thereafter, the psychologist or social worker will be available for further consultation and re-evaluation of the resident's behavior to ensure progress toward the identified treatment goals and to amend the current treatment plan as needed.

Additional Goals and Considerations of the Program:

That the resident has the right to be free from any chemical restraints that are administered for the purposes of discipline or convenience and that are not required to treat the resident‘s medical symptoms.” (Omnibus Reconciliation Act 1987)
The lowest possible dosage is used with every psychotropic medication and each psychotropic medication is appropriate for each resident's medical and psychiatric condition and presenting symptoms, so that full compliance with pertinent OBRA regulations is practiced or achieved.
Behavior management and/or supportive counseling is used prior to, or in conjunction with, psychopharmacological interventions, in an effort to reduce or eliminate the need for psychotropic drug therapy.
Psychotropic medications are not administered for the convenience of the staff.
Preventive measures are emphasized in all situations.
An optimal quality of life is the ultimate goal and measure of success.