Information Bulletin 00-10
Use Of Haldol In Nursing Homes
The purpose of this Informational Bulletin is to provide some clarification about surveyor guidelines for unnecessary of the drug Haldol (haloperidol) in nursing homes.
A copy of Program Letter #2000-13 is attached to this Bulletin.
Tag F330 States:
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;
The "guidance to surveyors" section of the state operations manual (SOM) under F330 lists the "specific conditions" and specifies that these conditions are quantitatively and objectively documented,... persistent,... are not caused by preventable reasons, and are causing the resident to: 1) present a danger to himself/herself or to others or 2) continuously scream, yell or pace....
This memo is a reminder that under current regulations continuous screaming, yelling or pacing without an associated condition listed in the SOM would not generally justify the use of haldol or other antipsychotic medication. This is not a new regulation but should serve as a reminder that haldol and other antipsychotic medications carry a significant risk of side effects and are not intended for use solely for behavioral control in non-psychiatric conditions.
Screaming, yelling and wandering behaviors occurring outside of the context of a psychiatric condition should be assessed for causal factors including physical or psychological discomfort, environmental or care related triggers and acute onset of a new condition. Haldol and other anti-psychotic medications are generally not warranted in the acute onset of these behaviors except occasionally on a short term basis when the behavior prohibits assessment for underlying causes or the behavior presents a danger to the individual or others.
This memo is not intended to signal a change in policy or a new mandate to discontinue all haldol or antipsychotic medication but to remind care givers that in view of the adverse effects associated with this class of medication, use must be well documented and restricted to the clinical situations as outlined in the SOM.
If you have any questions regarding this Informational Bulletin, please contact in writing: Minnesota Department of Health
Facility and Provider Compliance Division
Compliance Monitoring Division
85 East Seventh Place, Suite 300
PO Box 64900
St. Paul, MN 55164-0900
Voice: (651) 201-4101.
Health Care Financing
Chicago Regional Office, Midwest Consortium
ELECTRONIC REGIONAL PROGRAM LETTER #2000-13
DATE: May 4, 2000
FROM: HCFA, Chicago Regional Office, Division of Survey and Certification
SUBJECT: The Use of Haldol in Nursing Homes - INFORMATION
TO: State Survey Agency Directors
The purpose of this memorandum is to provide some clarification about surveyor guidelines for unnecessary drug use in nursing homes. Recently HCFA received concerns from Senators Grassley and Breaux stating our regulations and guidelines do not prevent a facility from using Haldol to stop a resident from screaming, yelling, or pacing.
Antipsychotic drugs should never be used to treat continuously screaming, yelling or pacing unless these behaviors are shown to be symptoms of specific conditions; (e.g., delusions, delirium), and that the other provisions of 483.25(l)(1)(2) are met. The symptoms of yelling and screaming, in and of themselves, do not justify use of an antipsychotic drug. The use of an antipsychotic drug is only appropriate when medically necessary to treat validated conditions, such as delirium and delusions.
Delusions are false beliefs (medical symptoms), which sometimes occur in elderly individuals with dementias. If they are frightened and disoriented, they may demonstrate conditions such as continuous yelling, screaming or pacing.
Sometimes the delusions can reflect minor fluctuations in a chronic condition, and do not constitute a problem requiring drug treatment. Other times, delusions may interfere with an individuals capacity to function or to enjoy life. In these cases the resident may benefit from the limited use of drugs such as Haldol. However, if the delusions are not harmful and do not impact negatively on the residents quality of life, then antipsychotic drugs should not be used. Surveyors are trained to carefully look for the evidence of each sampled individuals reason for receiving medications.
Delirium is an altered state of consciousness; that is, the person is not fully awake. Delirium can be caused by a physical illness that is not yet diagnosed, and can be life threatening when unrecognized and untreated. Sometimes, antipsychotic drug use may be acceptable for a limited time to stop a serious unwanted behavior while care givers diagnose and treat the underlying medical problem that may be causing the delirium and unwanted behavior. Current guidelines to surveyors regarding antipsychotic medications (located under quality of care) relate medical symptoms to acceptable conditions, and give surveyors further instructions regarding individual assessment of a given situation.
If you have any questions about this, please contact your Principal Program Representative.
Survey and Certification Program
Coordination and Improvement