Chemical Restraints/Unnecessary Psychotropic Medications

CMS has updated regulations to streamline oversight and ensure psychotropic medications are used only when medically necessary, with a significant emphasis on resident rights and informed consent. These updates aim to prevent misuse of medications and strengthen the focus on resident-centered care.

Key Changes:

1. Consolidation of Tags:
   • Tag F758 (Psychotropic Medications) is now integrated with F605 (Chemical Restraints) to create a more comprehensive regulatory framework.
   • Tag 757 (Unnecessary Medications) Non-psychotropic medications are addressed under separate guidelines, ensuring clear oversight of all medication use.
2. Informed Consent Requirements:
   • Before starting or increasing psychotropic medications, residents must be fully informed about the treatment and given the opportunity to accept or refuse the medication.
   • Informed consent involves detailed discussions about the purpose of the medication, potential risks, benefits, and alternatives.
3. Prohibition on Convenience Use:
   • Using psychotropic medications or restraints for staff convenience is explicitly prohibited. Facilities must demonstrate that the use of such medications is clinically justified and not merely a way to simplify care. They must have documented diagnosis and previous treatment revealing the need for and continuation of antipsychotic medication and psychotropics. Obtaining previous records is crucial. This includes completing PASARR 1 & 2 if indicated. 
4. Monitoring and Documentation:
   • Facilities must provide evidence that psychotropic medications are reviewed regularly, monitored for effectiveness, and adjusted as needed.
   • Medication use must align with a documented diagnosis and care plan. The care plan must be specific with what services are provided to a resident, especially when they have a PASARR 2 completed.

Book a Free Consultation

Strengthening Informed Consent:

What Informed Consent Entails:
Before initiating or adjusting psychotropic medications, facilities must ensure that residents or their legal representatives are involved in the decision-making process. The informed consent process includes the following steps:

1. Explanation of Purpose and Benefits:
   • Explain why the medication is being prescribed and how it aligns with the resident’s specific health needs.
   • Outline the expected outcomes, such as reducing distressing symptoms or improving quality of life.
2. Discussion of Risks and Side Effects:
   • Highlight potential side effects, including sedation, dizziness, or the risk of dependency.
   • Ensure the resident understands the long-term implications of the medication.
3. Presentation of Alternatives:
   • Explore and explain non-pharmacological options for managing symptoms, such as behavioral interventions, environmental modifications, or therapy.
   • Stress that medication is not the only option and seek the resident’s input.
4. Emphasis on Resident Autonomy:
   • Clearly state that the resident has the right to refuse treatment at any time.
   • Document any refusal or hesitation and collaborate with the resident to identify alternative solutions.

Facility Responsibilities:

1. Staff Training:
   • Train healthcare staff to facilitate clear, empathetic conversations about psychotropic medications and informed consent.
   • Reinforce the importance of respecting residents’ autonomy and documenting their choices.
2. Policy Updates:
   • Develop or revise policies to reflect the strengthened informed consent requirements.
   • Ensure processes for obtaining and documenting consent are well-defined and consistently applied.
3. Monitoring and Auditing:
   • Include psychotropic medication reviews in QAPI activities, tracking usage trends and ensuring compliance with CMS regulations.
   • Regularly review care plans and documentation to confirm alignment with informed consent standards.

Strengthening informed consent ensures that psychotropic medications are used only when necessary and appropriate, aligning with resident-centered care principles. By prioritizing transparency, choice, and effective communication, facilities not only comply with CMS requirements but also improve the overall quality of care and foster trust with residents and their families.