Dear Medical Director:
We realize that new CMS SNF Payroll-Based Journaling (PBJ) regulation has resulted in some confusion. While physicians are not legally required to log in and out of the building, there is still a contractual requirement to fill out monthly timesheets for your medical director duties.
The electronic copy of the timesheet is HERE for your convenience. A copy also may be found in the back of the Doctor to Doctor Medical Director Handbook, Second Edition. We may modify this timesheet in the near future, but for now I ask that you continue to use this one. Please submit it to your Executive Director.
LivingCenters should be invested in encouraging and documenting Medical Director administrative participation, as this has been shown to directly benefit patient care.
Michael Yao, M.D.
Chief Medical Officer
Last month at the Alzheimer’s Association International Conference in Toronto, researchers from Australia presented their findings from the Halting Antipsychotic use in Long Term care (HALT) project. In this study researchers trained facility nurses on non-pharmacologic management of behavioral and psychological symptoms of dementia (BPSD) in 23 long-term care facilities. The study recruited 140 residents, all of whom had a diagnosis of dementia and were on a regular antipsychotic medication though none of them had a primary psychotic illness. They were engaged in a gradual dosage reduction program and reassessed at three, six and 12 months following initial dosage reduction. Of these 140 residents, 132 had initiation of dosage reduction. 121 of these patients are off of medications to date, and 75% remain off of antipsychotic medications up to six months following the date of their initial antipsychotic reduction.
A brief overview of the study may be found in the Annals of Long Term Care at:
While it is not surprising that efforts to decrease antipsychotics can work, the high percentage of patient successes in this study when a patient-centered education program for staff is involved is notable. In your LivingCenters, GLC has made the CMS-approved Hand-in-Hand education available to all staff members through the GLC electronic Learning Management System. I encourage you to check into this yourself at : http://www.cms-handinhandtoolkit.info/. The training videos can be downloaded to computer to burn onto DVDs. I found that even though the training is geared toward a general caretaking staff population, and thus do not require medical expertise, I learned much about communication with demented patients from the videos.
Without culture change and a team that understands patient-centered dementia care who are comfortable handling “problem behaviors” of patients with dementia, efforts at antipsychotic reduction are not likely to be sustainable. Education and reinforcement is vital and you can play an important role here.
Golden LivingCenters has been able to reduce antipsychotic usage in our long-term patients significantly, but there is still work to be done. Please feel free to contact me if you have any questions regarding how to further antipsychotic reduction in your LivingCenter.