The NH is saying that a regulation (F329) requires me to agree to my husband having a reduction of his zyprexa, which is being used to treat his Parkinson's. I don't want to do it and neither does his neurologist. What are my rights?
I have two thoughts as a retired NH administrator. First and foremost, your husband's neurologist should be talking directly with your husband's attending physician. This way the communication can be focus on what is really in your husband's best interest. You may be the best person to get this discussion initiated by requesting that the attending call the neurologist. I am assuming that you understand the neurologist's reasoning for ordering this medication as it pertains to your husband's Parkinson's. Secondly, although facilities are under some pressure to reduce the frequency/dose of anti-psychotics and mood altering meds, it is not expected that all residents will have their meds reduced or eliminated. You have the right to be your husband's primary advocate, which means you have the responsibility to get a full understanding of your husband's medications, purposes, side effects, etc. so that you can be an informed part of the ongoing discussion regarding his care. Physicians can be rather bull headed, but that doesn't necessarily mean they are always correct in their reasoning. The facility has the responsibility to ensure that all of the residents under their care are receiving the right medications for the right reason. I think this issue all comes down to getting everyone involved to understand the reason your husband is on the Zyprexa, and assuming that it is truly justified, everyone should be able to get on the same page. Finally, the regulation in question does not say anything about the family needing to be in agreement, but you do need to be informed of changes and I suspect that the form is just to document that you have been informed. May God bless.
First of all, this drug is used as an antipsychotic, not for Parkinson's. Is he having hallucinations or acting out in the nursing home? One reason could be weaning him off by slowly reducing the drug, but I've never heard of a "mandatory" reduction of a drug. A doctor would have to approve such an order, so try to coordinate his NH doctor with his neurologist.
Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that: (i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and (ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.
So there is a move to reduce these drugs but the issue is AND BEHAVIOURAL INTERVENTIONS UNLESS CLINICALLY CONTRAINDICATED
HOWEVER Zyprexa does carry a caution for elderly people and for some people can exacerbate conditions - what are they planning to do in terms of monitoring and intervention? Is it in the care plan? if not why not? How long is the initial monitoring period? Who is recording? What access to records will you have in terms of immediacy - i.e. I want to see the records now (not tomorrow after someone has completed them as they should have done! - yes it happens).
It is not for you to agree you can clearly state your concerns and I would want the neuro's input recognised too in writing so that you do have a comeback if the trial is not successful. That said if it improved his condition it would be worth it.
F329 mandates that antipsychotic drugs not be given indiscriminately, without cause and used as a chemical restraint.
It may be that he can be maintained on a lower dose. Since he is in care, you might agree to a gradual reduction and see if it makes a difference. He can be closely monitored. Talk this over with the DoN AND his doctor.
Mandatory my foot! You are NOT required to agree to that and you can tell them "Look, I know the government wants meds cut back, but I'm not married to the government. Tell them to take a hike." and refuse to sign.
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May God bless.
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Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that:
(i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and
(ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.
So there is a move to reduce these drugs but the issue is AND BEHAVIOURAL INTERVENTIONS UNLESS CLINICALLY CONTRAINDICATED
HOWEVER Zyprexa does carry a caution for elderly people and for some people can exacerbate conditions - what are they planning to do in terms of monitoring and intervention? Is it in the care plan? if not why not? How long is the initial monitoring period? Who is recording? What access to records will you have in terms of immediacy - i.e. I want to see the records now (not tomorrow after someone has completed them as they should have done! - yes it happens).
It is not for you to agree you can clearly state your concerns and I would want the neuro's input recognised too in writing so that you do have a comeback if the trial is not successful. That said if it improved his condition it would be worth it.
M88
It may be that he can be maintained on a lower dose. Since he is in care, you might agree to a gradual reduction and see if it makes a difference. He can be closely monitored. Talk this over with the DoN AND his doctor.