Falling medication

Great Plains Quality Innovation Network recently updated its Antipsychotic Reduction Resident Prioritization Tool. This tool is designed to assist an interdisciplinary team to identify where to begin a gradual dose reduction of antipsychotic medications and which residents to include. Access a short video tutorial on how to use the tool.

Nursing homes can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The prioritization tool can be very helpful in reducing use and avoiding fines and penalties.

A recent national study published in the Journal of Post-Acute and Long-Term Care Medicine (JAMDA),  surveyed 3,526 nursing homes to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for nursing home residents with dementia. The three most common reasons for F-758 citations included 1) failure to identify and/or monitor behavioral symptoms; 2) attempt gradual drug reduction; and 3) maintain 14-day limitations on PRN psychotropic orders. This study suggests areas for improvement that could potentially reduce inappropriate psychotropics which includes supporting quality of dementia care workforce and improving cooperation within healthcare staff and professionals to ensure proper nonpharmacologic and pharmacologic interventions.

2021 Q4 GPQIN AP QM Trending Graph Ending 2021 Q4


North Dakota and South Dakota nursing homes have a higher than national average for long stay residents who received an antipsychotic medication (Care Compare – 2021 Q1 – 2021 Q4)



Lori Hintz“Nursing homes wanting to reduce antipsychotic medication use, often look for direction on where to start and what can they focus on first. The Antipsychotic Reduction Resident Prioritization Tool provides an easy-to-use algorithm to identity those residents who should be considered first.  As with many things, to keep motivation and efforts moving forward, one typically needs a ‘win’. This tool will help you pinpoint those potential first easy ‘wins’ before advancing to more challenging situations in reducing antipsychotic medications in your nursing home.” shared Lori Hintz; Quality Improvement Advisor with Great Plains QIN.

The Biden Harris Administration is working on major nursing home reform.  Amongst the many reform ideas is reinforcing safeguards against unnecessary medications and treatments.  Specifically, the plan addresses identifying problematic diagnoses’ and refocusing efforts to lower inappropriate use of antipsychotic medications¹.  With North Dakota and South Dakota reaching near 20% antipsychotic medication rates, we are now among the highest in the nation. The national average is 14%².  It is inevitable, we will be tasked to address these high rates.

Great-Plains-QIN-Antipsychotic-Reduction-Resident-Prioritization-Tool_The Centers for Medicare & Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists.

Do you know what your facility antipsychotic medication rate is? If it is over 12%, there is a very good chance you can find several reduction opportunities.  It is also likely a F-758 citation may be looming in your future with continued high antipsychotic medication use.

The Great Plains QIN team is available to assist with understanding and implementation of the Antipsychotic Reduction Prioritization Tool. Visit the Who We Are page of this site to be connected to a Quality Improvement Advisor for assistance.


  1. White House Fact Sheet: Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes | February 28, 2022
  2. CMS.GOV; MDS Frequency Report Nursing Home | Updated December 2021
  3. Deficiency Citations on Inappropriate Psychotropics Use Related to Care for Behavioral Symptoms of Dementia | Authors: Jung Min Yoon, PhD, RN; Alison M. Tinkoff, ScD, MPH, RN, FAAN; Elizabeth Galik, PhD, CRNP, FAAN, FAANP; Carla L. Storr, ScD, MPH; Nancy B. Lerner, DNP, RN, CDONA; Nicole Brandt, PharmD, MBA, BCGP, BCPP, FASCP; Shijun Zhu, PhD, DrE | Published: May 11, 2022DOI:https://doi.org/10.1016/j.jamda.2022.04.006
  4. F-tags study reveals common misuses of psychotropic drugs in LTC; McKnights Publication | May 13, 2022