by Donna Renee Williams, RN, MBA, CDONA/LTC

The California Partnership to Improve Dementia Care held a conference call on May 29, 2013.  The agenda included an update on the status of antipsychotic medication use in California skilled nursing facilities.  Although various organizations were represented, including the Centers for Medicare and Medicaid Services (CMS), the call seemed to lack adequate representation, the voice of those with an intimate connection with the skilled nursing facility itself.  This may have been due to technical difficulties and a limitation to the number of callers not anticipated by the coordinators.

Nevertheless, here are a few key points from the call:

No representative from CDPH was on the call; however, they may not have been able to connect as many others have indicated an inability to join in.

Data on the utilization of psychotropic medication with comparative statistics for California versus other regions:  The total percentage of all deficiencies issued under Federal Tag 329 (F329) Unnecessary Medications for 2010 and 2012 were 29.19% and 27.9%, respectively.  However, it is important to note that a deficiency associated with this regulation is not exclusive to antipsychotics and is inclusive of all drug classifications. Nationally, this percentage was 19.8%.

Region 9 (which includes Nevada, American Samoa, Arizona, California, Guam, Hawaii, Northern Mariana Islands), ranked third-highest in issuing F329 deficiencies.  This is despite the fact that the overall percentage of residents receiving antipsychotics is lower than the national average.

There was discussion as to which organization would be in charge of Phase II (according to the invitation for the call, the recommendation is for the California Culture Change Coalition), in addition to ideas for meeting and summits.  One caller suggested from her personal experience and perspective a need for focused training on delirium versus dementia, further stating that physicians may be mislabeling patients with delirium as having dementia.

Upon conclusion of the call, coordinators have suggested that an in-person meeting in Sacramento be scheduled for either July or August in addition to a separate meeting for Southern California in Los Angeles.  CALTCM’s leadership will continue to be active participants in this partnership and hope to assist Culture Change and other organizations in educating prescribers and influencing change in this important arena of patient quality and safety.