Harmony Healthcare Blog

Quality Measures # 16:  Residents Who Received an Antipsychotic Medication - Long Stay (Part 1)

Posted by The Harmony Team on Tue, Oct 18, 2016

Edited by Kris Mastrangelo


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

antipsychotics.jpgRoot Cause Analysis 

The first step in drilling down to the root cause of this Quality Measure is to understand how the measure is calculated.  This measure reports the percentage of long-stay residents who are receiving antipsychotic drugs within the target period. 

Understanding the Defined Criterion 

  • This particular measure looks at the percentage of long stay residents who received an antipsychotic medication during the target period identified on the Casper Report.
  • This Long Stay Quality Measure is calculated and used both in the Five Star reporting system and the Public Reporting Nursing Home Compare website. 


  • Long-stay residents with a selected target assessment where the following condition is true of their look-back scan assessment have the following question: 
  • [N0410A] - Antipsychotic medications received. This condition is defined as follows:
    1.  N0410A = [1, 2, 3, 4, 5, 6, 7]. 


  • Long-stay residents with a selected target assessment, except those with exclusions.

    1.  The resident did not qualify for the numerator and any of the following is true:
    • N0410A = [-]
    • Any of the following related conditions are present on the target assessment (unless otherwise indicated):
      • Schizophrenia (I6000 = [1]).
      • Tourette’s syndrome (I5350 = [1]).
      • Tourette’s syndrome (I5350 = [1]) on the prior assessment if this item is not active on the target assessment and if a prior assessment is available.
      • Huntington’s disease (I5250 = [1])


Managing psychiatric and disease related behavioral issues in the elderly has always been challenging in the skilled nursing facility. The increased awareness of the adverse consequences of these medications along with the requirement to attempt a Gradual Dose Reduction (GDR) has made this process more challenging. 

  • CMS has very specific and detailed guidelines related to how facilities are to address the use of psychoactive medications. Details of this regulation can be found in Section 483.25 of the State Operations Manual and issues are generally cited under Tag F329. 
  • While all medications are required to be monitored closely, psychoactive medications, specifically antipsychotics, require even more diligent monitoring for the facility to avoid adverse consequences of use and potential compliance issues. 

What is the next step? 

Understanding the clinical Focus and Developing a Behavior Monitoring Process. In the upcoming blog post, Part II of Quality Measure #16: Residents Who Received an Antipsychotic Medication – Long Stay, Harmony Healthcare International (HHI) will provide insight on how to develop a comprehensive process. Topics will include Clinical Focus, Clinical Management Strategies, Root Cause Analysis and Development of a Behavioral Root Cause Analysis Process. 

Harmony Healthcare International (HHI) is available to provide onsite analysis and associated medical record reviews to help you improve your Quality Measure Scores.   Please contact Harmony Healthcare International by clicking here or calling our office at 1.800.530.4413.


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Tags: Quality Measures, Antipsychotics

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