A Sustainable Interdisciplinary Approach to the Appropriate Use of Antipsychotic Medications in Long-Term Care

2021 ◽  
Vol 22 (1) ◽  
pp. 182-184 ◽  
Author(s):  
Innokentiy Bakaev ◽  
Mary McDougall ◽  
Tammy B Retalic ◽  
Julie Mooza
Keyword(s):  
Long Term Care ◽  
Interdisciplinary Approach ◽  
Appropriate Use ◽  
Term Care ◽  
Antipsychotic Medications

scholarly journals Nurse Practitioners and The Use of Antipsychotic Medications in Long Term Care in Ontario, Canada

2021 ◽  
Author(s):  
Laura Elizabeth Hill NP-Adult, MScN ◽  
Roberta Heale NP-PHC, DNP, PhD
Keyword(s):  
Nurse Practitioners ◽  
Long Term Care ◽  
Inappropriate Prescribing ◽  
Care Staff ◽  
Front Line ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Line Staff

Introduction: Antipsychotic use in Long-Term Care (LTC) in Ontario, Canada continues to pose a challenge in the care of older adult patients living in these institutions. The dangers and patterns of inappropriate prescribing have been documented frequently. Most of the current literature focuses on dementia and behavioral and psychological symptoms of dementia, the role of prescribers, or on interprofessional interventions with person-centered care to address the behavior. Very little discussion has focused on the role of nurse practitioners and other frontline long-term care staff in the assessment and interactions with residents that may result in prescriptions of antipsychotics. Objectives: The purpose of this population based retrospective study of data from all LTC facilities in Ontario, Canada in 2019-2020 was to determine the extent to which antipsychotic medications were used in and the factors associated with this use. Reflections about the NP role are discussed. Results: The results demonstrate that over thirty percent of residents in LTC continue to receive antipsychotics and those with the responsive behaviours are significantly more likely to be prescribed antipsychotics.   Conclusions: The findings identify a potential link between over-burdened front-line staff and increased antipsychotic prescriptions, as well as continued use of antipsychotics in attempts to prevent harm to residents and staff at long-term care homes. Recommendations are made that include changes to legislation that will ensure optimal front-line care and time for care, increased training for front line staff and, in particular, how the role of the nurse practitioner in LTC can be utilized to optimize the appropriate use of antipsychotics, and the support of discontinuing or decreasing the dose of antipsychotics when required.

scholarly journals Effect of a multimethod quality improvement intervention on antipsychotic medication use among residents of long-term care

2021 ◽  
Vol 10 (2) ◽  
pp. e001211
Author(s):  
Heather M Hanson ◽  
Tova Léveillé ◽  
Mollie Cole ◽  
Lesley JJ Soril ◽  
Fiona Clement ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antipsychotic Medication ◽  
Long Term Care ◽  
Medication Use ◽  
Implementation Fidelity ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Term Care ◽  
Antipsychotic Medications

BackgroundAntipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted to address inappropriate antipsychotic medication use in long-term care (LTC) in the province of Alberta.MethodsWe conducted a multimethod evaluation of the provincial implementation of the project in 170 LTC sites over a 3-year project period incorporating a quasi-experimental before–after design. Using a three-component intervention of education and audit and feedback delivered in a learning workshop innovation collaborative format, local LTC teams were supported to reduce the number of residents receiving antipsychotic medications in the absence of a documented indication. Project resources were preferentially allocated to supporting sites with the highest baseline antipsychotic medication use. Changes in antipsychotic medication use, associated clinical and economic outcomes, and the effects of the project on LTC staff, physicians, leaders and administrators, and family members of LTC residents were assessed at the conclusion of the implementation phase.ResultsThe province-wide initiative was delivered with a 75% implementation fidelity. Inappropriate antipsychotic medication use declined from 26.8% to 21.1%. The decrease was achieved without unintended consequences in other outcomes including physical restraint use or aggressive behaviours. The project was more expensive but resulted in less inappropriate use of antipsychotics than the pre-project period (incremental cost per inappropriate antipsychotic avoided of $5 678.71). Accounts from family, organisational leaders, and LTC staff were supportive of the project activities and outcomes.ConclusionThis quality improvement initiative was successfully delivered across an entire delivery arm of the continuing care sector. Quality of care in LTC was improved.

scholarly journals INAPPROPRIATE PRESCRIBING OF ANTIPSYCHOTIC MEDICATIONS IN LONG TERM-CARE RESIDENTS: THE HALT PROJECT

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 968-968 ◽  
Author(s):  
F. Harrison ◽  
M. Cations ◽  
T. Jessop ◽  
A. Shell ◽  
H. Brodaty
Keyword(s):  
Long Term Care ◽  
Inappropriate Prescribing ◽  
Term Care ◽  
Antipsychotic Medications

Prolonged use of antipsychotic medications in long-term aged care in Australia: a snapshot from the HALT project

2020 ◽  
Vol 32 (3) ◽  
pp. 335-345 ◽  
Author(s):  
Fleur Harrison ◽  
Monica Cations ◽  
Tiffany Jessop ◽  
Liesbeth Aerts ◽  
Lynn Chenoweth ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Long Term Care ◽  
Psychological Symptoms ◽  
Functional Dependence ◽  
Aged Care ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Care Facilities ◽  
Sydney Australia

ABSTRACTObjectives:Use of antipsychotic drugs in long-term aged care (LTC) is prevalent and commonly exceeds the recommended duration, but contributors to this problem are not well understood. The objective of this study is to provide a snapshot of the features of and contributors to prolonged use of antipsychotic medications (>12 weeks) among a sample of LTC residents.Design:We present retrospective and baseline data collected for the Australian Halting Antipsychotic Use in Long-Term Care (HALT) single-arm longitudinal deprescribing trial.Setting:Twenty-four long-term care facilities in Sydney, Australia.Participants:The HALT study included 146 older people living in 24 Sydney LTC homes who had been prescribed a regular antipsychotic medication for at least 3 months at baseline.Measurements:Detailed file audit was conducted to identify the date and indication recorded at initial prescription, consenting practices, longitudinal course of prescribing, and recommendations for review of antipsychotic medication. Behavioural and psychological symptoms of dementia (BPSD) and functional dependence at baseline were assessed via LTC staff interview. Cognition at baseline was assessed in a participant interview (where possible).Results:Antipsychotics were prescribed for 2.2 years on average despite recommendations by a doctor or pharmacist for review in 62% of cases. Consent for antipsychotic prescription was accessible for only one case and contraindications for use were common. Longer use of antipsychotics was independently associated with higher dose of the antipsychotic drug and greater apathy, but not with other BPSD.Conclusion:Antipsychotic medications appeared to be prescribed in this sample as a maintenance treatment in the absence of active indicated symptoms and without informed consent. Standard interventions, including recommendations for review, had been insufficient to ensure evidence-based prescribing.

Halting Antipsychotic Use in Long-Term care (HALT): a single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioral and psychological symptoms of dementia

2017 ◽  
Vol 29 (8) ◽  
pp. 1391-1403 ◽  
Author(s):  
Tiffany Jessop ◽  
Fleur Harrison ◽  
Monica Cations ◽  
Brian Draper ◽  
Lynn Chenoweth ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Long Term Care ◽  
Psychological Symptoms ◽  
Care Staff ◽  
Secondary Outcome ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Inappropriate Use ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground:Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management.Methods:LTC facilities will be recruited across Sydney, Australia. Resident inclusion criteria will be aged over 60 years, on regular antipsychotic medication, and without a primary psychotic illness or very severe BPSD, as measured using the Neuropsychiatric Inventory (NPI). Data collection will take place one month and one week prior to commencement of deprescribing; and 3, 6 and 12 months later. During the period prior to deprescribing, training will be provided for care staff on how to reduce and manage BPSD using person-centered approaches, and general practitioners of participants will be provided academic detailing. The primary outcome measure will be reduction of regular antipsychotic medication without use of substitute psychotropic medications. Secondary outcome measures will be NPI total and domain scores, Cohen-Mansfield Agitation Inventory scores and adverse events, including falls and hospitalizations.Conclusion:While previous studies have described strategies to minimize inappropriate use of antipsychotic medications in people with dementia living in long-term care, sustainability and a culture of prescribing for BPSD in aged care remain challenges. The HALT project aims to evaluate the feasibility of a multi-disciplinary approach for deprescribing antipsychotics in this population.

scholarly journals Development and pilot testing of a decision aid for the initiation of antipsychotic medications in persons with dementia in long-term care using a systematic approach: a study protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e018769
Author(s):  
Leslie J Malloy-Weir ◽  
Andrew Kirk
Keyword(s):  
Phase I ◽  
Study Protocol ◽  
Decision Aid ◽  
Long Term Care ◽  
Neuropsychiatric Symptoms ◽  
Phase Iii ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Pilot Testing

IntroductionAntipsychotic medications are commonly used in long-term care to treat neuropsychiatric symptoms of dementia despite concerns that their risks (eg, infection, falls, death) may outweigh their benefits. This study protocol outlines the development and pilot testing of a decision aid for antipsychotic medications that is tailored to the information needs of residents with dementia in long-term care and family caregivers (or decision makers). The goals of the decision aid are to help residents and caregivers (1) better understand the risks and benefits of antipsychotic medications in long-term care, and (2) make informed decisions about their use (or non-use).Methods and analysisThis multiphased study is being conducted between October 2016 and September 2018. In phase I, the decision aid will be developed after consultation with a steering group, review of scientific evidence on outcomes associated with pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care, review of guidelines for the use of antipsychotic medications in long-term care, and review of guidelines for writing health information for patients and families. The decision aid will also be alpha-tested and redrafted, as necessary, in phase I. In phase II, implementation and reporting guidelines for the decision aid will be developed in collaboration with Directors of Care in long-term care. In phase III, the decision aid will be (1) beta-tested with residents with dementia in long-term care and caregivers not involved in the design phase, and (2) assessed by an external panel of experts.Ethics and disseminationEthical approval for this study has been granted by the Research Ethics Board at the University of Saskatchewan, approval number Beh 16-465. Findings from this study will be disseminated via conference presentations, publications, presentations to policy makers and plain language summaries to residents with dementia in long-term care and their caregivers.

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