Date of Graduation

Spring 5-6-2014

Document Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Karen Van Leuven

Second Advisor

Dr. Robin Buccheri

Third Advisor

Dr. Jo Loomis


There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve quality of life, and reduce patient and caregiver distress. The purpose of this quality improvement project was to implement use of an evidence-based psychotropic risk assessment checklist, that integrates palliative medicine with the dementia disease trajectory, to guide treatment decisions for psychotropic risk reduction, and improve the documentation of outcome measures and person-centered care. The checklist was initially used in four separate skilled nursing facilities over a period of eight weeks. The adoption of the checklist to change practice patterns, and influence the prescribing culture in the nursing homes, was founded on Roger’s Diffusion of Innovation theory (Rogers, 2003). Evaluation methods included qualitative impact results from the interdisciplinary team, and chart review for increased utilization and documentation of non-pharmacological interventions, and shared-decision making on goals of care. Additional future outcomes may include, reduced psychotropic use for public reporting with national benchmarking, and improved survey results from oversight and regulatory organizations. The checklist is simple yet comprehensive, has good feasibility for long-term care, and is projected to expand to the electronic health record for clinician access and utilization in diverse settings.