Published On: 01-01-2019

In 2011, the Office of Inspector General (OIG) of the Department of Health and Human Services released the report Medicare Atypical Antipsychotics Drug Claims for Elderly Nursing Homes Residents. This report was prompted by a legislator’s concern about the extent that elderly nursing home residents were receiving antipsychotic medications for off-label conditions. OIG staff evaluated Medicare claims data from Part B and Part D and the Minimum Data Set (MDS) to identify Medicare payments for atypical antipsychotic drugs for elderly (65 years and older) nursing home residents from January 1, 2007, to June 30, 2007. The OIG report revealed a clear picture of overuse of atypical antipsychotic medication for elderly nursing home residents in the United States and that the cost of the overuse had financial implications for the Medicare program. Importantly, antipsychotic medications reportedly were placing elderly nursing home residents at risk for medical complications and increased risk of early death. In 2007 and 2011, the Agency for Healthcare Research and Quality confirmed these findings in comparative effective reviews. Adverse events reported for atypical antipsychotic use among elderly nursing home residents were urinary symptoms, extrapyramidal symptoms, and increased risk of death.

The findings from these reports prompted the Centers for Medicare & Medicaid (CMS) in 2012 to establish a National Partnership to Improve Dementia Care in Nursing Homes.4,5 This private-public partnership developed a multidimensional strategy to address the public health issue affecting 14% of the nursing home population and health care costs. According to the 2011 OIG report, the costs of overuse of antipsychotic medication toMedicare was $309 million during the 6 months preparing the report.

The purpose of this article is to share the quality improvement (QI) efforts to reduce antipsychotic medication use in nursing home residents in a federally funded initiative that used full-time advanced practice registered nurses (APRNs). These APRNs were embedded in 16 nursing homes in Missouri from 2014 to 2016.

Flesner, M., Lueckenotte, A., Vogelsmeier, A., Popejoy, L., Canada, K., Minner, D., Galambos, C., & Rantz, M. (2019). Advanced practice registered nurses’ quality improvement efforts to reduce antipsychotic use in nursing homes. Journal of Nursing Care Quality, 34(1), 4-8.

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