IDT Challenge

by Flora Y. Bessey, PharmD, CGP

This past month you have heard the awesome accomplishment the ice bucket challenge has generated for ALS donations and overall awareness.  Along the same lines, I challenge you all to learn the IDT process at your facility surrounding antipsychotic medication use.

The CDPH All Facilities Letter which came out earlier this month is very specific about the expectations from facilities for resident with antipsychotics.  (Read Dr. Tim Gieseke’s article Added Incentive to Reduce Inappropriate Antipsychotic Use.)

What can facilities do to ensure compliance and avoid having a pharmacist on the survey team?  As a consultant pharmacist, I work hard to ensure my facilities have all the appropriate information documented.  In my experience, successful facilities have concise documentation with an interdisciplinary team consisting of social services, activities, nursing, and the consultant pharmacist participate in reviewing the appropriateness of psychotropic medication use.

In the facilities where a physician, psychiatrist or clinical psychologist attend the IDT meeting dealing with psychotropics, the documentation is more concise and complete.  This also makes the documentation process seamless.  New orders can be generated at the time of review.  Risk, benefit and consequences statements can be documented.  This may seem like an unrealistically, ideal situation, but when it occurs, I have seen it work wonders.

Most physicians struggle with writing risk/benefit statements because, what are you supposed to say?  We can’t take this patient off this medication; they are too difficult to take care of otherwise?  We are using Seroquel 12.5mg PO QHS off label for sleep because without it, the resident doesn’t sleep and doesn’t let anyone else sleep?  Yes, it’s off label but we have tried Ambien and Restoril and it just doesn’t work as well as Seroquel for this resident?  This is at odds with our practical experiences, since we were taught not to “over document.”

In this one case, documenting properly the need for continued antipsychotic use will save you and the facility great distress at the time of survey.  If a physician, especially a psychiatrist, can be involved at the point of documentation, it is so much easier to accomplish the necessary documentation. If a previous reduction has failed, indicate what happened when a reduction was attempted!

I am not asking you to pour a bucket of ice cold water over your head and share the video with your friends on social media.  What I am asking is for you to make an effort to participate in the IDT process at your facility. Let’s take care of our patients and our facilities.

Click here and share your IDT successes with our community!