RE: Antipsychotic Med Policy

[k.karren]

Part of our routine nursing home orders (which all physicians sign prior to admission) includes need for diagnosis for each med,  nurses also get a diagnosis for new meds ordered, once in a while one will get missed and I do the same as Michelle – send the MD a note.  As part of initiating a new psychotropic med, resident or POA signs consent and physician gives us a diagnosis before we give the med.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Michelle Witges Sent: Tuesday, December 16, 2003 2:15 PM To: [EMAIL PROTECTED] Subject: Re: Antipsychotic Med Policy   Whenever I discover that there is a drug without a dx I have a form that lists the meds and asks the MD for diagnosis.  This is the only thing I have found to work.  I have educated and asked nurses to ask MD for dx when they get an order but they didn't like to "question" the MD.  I list all meds and the MD's will fill it out and return it to me. Michelle ----- Original Message ----- From: Corey Ali To: [EMAIL PROTECTED] Sent: Tuesday, December 16, 2003 1:33 PM Subject: Re: Antipsychotic Med Policy   Holly, This was something an "old homey" nursing facility I was at years ago implemented.  It has worked well since, and in other places as well.    The policy was that the medical practioner has to indicate the dx. that the medication was for, to "help the nurses understand".  It was something of a trick, but it worked well since, and is popular in many facilities in this area.    For example:   Synthroid (dosage) for low thyroid. Prozac (dosage): depression Haldol: dx. Schizophrenia ASA: hx. DVT   Of course, you then had to keep after them to document at least every 6 months on the dx. and s/s, and either stability, improvement or decline, but our shrink was just great in doing that for the psychotropics.   Corey ----- Original Message ----- From: Holly Sox, RN, RAC-C To: [EMAIL PROTECTED] Sent: Tuesday, December 16, 2003 1:32 PM Subject: Antipsychotic Med Policy   Hi, Group, One citation we received on Survey was for antipsychotic use without the appropriate dx. I have really been tearing my hair out with psychotropic meds in general since starting here a year ago.  I have developed a letter to send to MD when antipsychotic is initiated without the proper dx as well as when I find one already on the med without dx.  I suggested implementing a policy of not starting antipsychotic med until the form was completed by the physician, but DON and Administrator both said they felt uncomfortable with a policy of not following a physician's order.   But, is that any different from not following any other inappropriate order without clarification??? For example, I wouldn't start IVF at 300 cc/hour on a CHF patient, just because the doctor ordered it.   Could any of you who are "lurking" surveyors (Yeah, you, MR), send me some guidance (along with links to supporting regulations, etc)?  Also, what are other facilities doing as far as P/P for antipsychotic meds? Thanks! Holly  Holly F. Sox, RN, RAC-C Clinical Editor   www.careplans.com   [EMAIL PROTECTED]