“With the low average length of stay in inpatient psychiatric units, it is common for patients to continue a cross-taper between medications after discharge,” Dr. Pandya says. “For most antipsychotic medications, there is insufficient data to determine how fast or slow to cross-taper. I worry that these standards may send the unintentional message that these cross-tapers should be completed quickly during the course of a brief inpatient stay.”
Data suggest individuals using lithium should be tapered off the drug as slowly as possible—probably over months rather than weeks, Dr. Pandya says. “I am concerned that tracking data regarding patients on multiple antipsychotic medications may create incentives to change practice in a sub-optimal direction for some cases,” he says.
Dr. Duckworth also acknowledges patients’ length of stay is getting shorter. Psychiatric hospitalists are under a great deal of pressure to “get people patched up in too short a period of time,” he says. “They really do need more time. There is a temptation to use more than one antipsychotic medication, but people really should not be given two antipsychotic medications unless someone has performed a thoughtful assessment.”
On Board with HBIPS
While HBIPS covers areas of care important to many, the details of implementing the measure set might be challenging, Dr. Lineberry says. The requirements increase the documentation burden for physicians, nurses, and allied health professionals, such as social workers and therapists. Hospitals using electronic medical records might have to modify their records to meet the requirements. And with the new measure comes new, significant personnel costs to audit and collect the data, he says.
“For psychiatric hospitalists who are using HBIPS, it will be helpful to look at the measures from a multidisciplinary standpoint,” Dr. Lineberry says. “Approach HBIPS as a team. Look at the process and see how it works, then adapt it to fit in with your current workflow.”
As of July, more than 274 psychiatric hospitals and psychiatric units had implemented the HBIPS measures. “We don’t usually have numbers until at least six months after,” Milton says, noting the commission is eager to receive quantitative data and report back to the participating hospitals.
Milton anticipates the Joint Commission will submit the HBIPS measure set to the National Quality Forum (NQF) for consideration and endorsement. Although she anticipates the measures will receive NQF endorsement sometime this year, an exact timeline has not been established, she says. The Joint Commission will work closely with the NQF to ensure the HBIPS measure set receives endorsement, and will make necessary modifications that may be required, Milton says.
Once HBIPS receives NQF endorsement, HBIPS data will be publicly reported following the first two quarters of data collection, Milton says. Data on each hospital will be available at www.qualitycheck.org. TH
Gina Gotsill is a freelance medical writer in California. Freelance writer Chris Haliskoe contributed to this report.
Image Source: TIM TEEBKEN/PHOTODISC