Behavior Monitoring | What You Need to Know
When is behavior monitoring required?
In long-term care, medications are often prescribed to treat “behaviors”. Sometimes these behaviors are symptoms of dementia or other psychotic conditions. The F tag – F329 (Unnecessary Medications) can be cited by surveyors when medications are administered with insufficient monitoring. All medications administered to a resident should be monitored for effectiveness. When a medication is started to treat hypertension, blood pressure readings are monitored. Similarly, when a medication is started to treat a specific behavior we need to monitor that behavior. Antipsychotics, antidepressants, anti-anxiety, mood stabilizers and several other classes of medications can require behavior monitoring. The key is to determine why the medication was started when deciding if behavior monitoring is required. When determining if a medication requires behavior monitoring ask yourself: How do I know the medication is working?
Antidepressants to treat depression are typically monitored utilizing various depression screens or mood questionnaires and thus might not require a behavior monitoring sheet. However if that same antidepressant is prescribed to treat inappropriate sexual behaviors or symptoms of OCD, a behavior monitoring sheet would be a great tool to monitor for effectiveness. This is true across all medication classes, remember to ask yourself: How do I know the medication is working?
What behaviors should be monitored?
A behavior is a reaction to a stimulus or situation. Your goal when deciding what behavior to monitor should be to identify the specific behavior that occurred resulting in the medication being started or the behavior that occurred when a prior dose reduction failed. Non-specific behaviors such as agitation, wandering, anxiety, sadness, calling out, and yelling should be avoided and never used on a behavior monitoring sheet. The more specific the behavior being monitored, the more valuable and accurate the data will be. If a resident is agitated, describe how you know that resident is agitated. That is the “behavior” or symptom you want to write down on the behavior monitoring sheet.
Do you have further questions and need clarification? This can be a confusing and complicated issue with numerous medications and off-label prescribing typical of Long-Term Care. Our AlixaRx Clinical Pharmacist are a great resource for medication and behavior monitoring questions!
This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.