Gradual Dose Reduction (GDR) is a CMS requirement for residents receiving psychotropic medications. Understanding when GDR is required and how to document it properly is essential for F758 compliance.
What is GDR?
GDR is the systematic reduction of a psychotropic medication to determine if the medication is still necessary or if a lower dose would be effective. CMS requires facilities to attempt GDR unless clinically contraindicated.
When is GDR Required?
GDR Required
- • Antipsychotics without qualifying diagnosis
- • Anxiolytics beyond initial treatment period
- • Sedative-hypnotics for extended use
- • Medications without documented behavioral targets
GDR May Be Contraindicated
- • Documented psychiatric diagnosis requiring maintenance
- • Previous failed GDR attempts with symptom return
- • Physician documentation of clinical necessity
- • End-of-life comfort care
Documentation Requirements
If GDR is Attempted
Document the reduction schedule, monitoring plan, behavioral observations during reduction, and outcomes.
If GDR is Contraindicated
Document the clinical rationale, supporting diagnosis, previous GDR attempts, and physician justification.
F758 Connection: Surveyors specifically look for GDR consideration and documentation. Facilities that cannot demonstrate GDR attempts or provide clinical justification for not attempting GDR are at high risk for citations.
How QAPIShield Supports GDR Compliance
- Track GDR consideration status for each resident
- Alert when GDR review is due
- Document contraindication rationale
- Generate survey-ready GDR reports
