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Antipsychotics - Appropriate Use

Two Covenant Health (COV) sites, St. Michael’s Health Centre in Lethbridge and Youville Home in St. Albert, were part of the Appropriate Use of Antipsychotics (AUA) pilot project that was launched in June 2013 by Alberta Health Services (AHS).  The pilot project was a huge success.

In May 2014, COV received funding from the Network of Excellence in Seniors Health and Wellness to support the COV AUA project.  With support from AHS Seniors Health and Addiction & Mental Health Strategic Clinical Networks, COV has implemented best practices for antipsychotic mediation use in all COV long-term care (LTC) sites and piloted two supportive living units, treating dementia residents across the province with more holistic and individualized care. 

Project Implementation

To support the implementation of this project, a COV project structure was formed which included the COV AUA Oversight Committee which in turn reported to the COV Executive Sponsor.  This committee oversaw and provided direction and support for the implementation.

Higher Sites/Units Group
LTC sites/units with greater than 25% Antipsychotic Quality Indicator (QI) from January to March 2014 were invited to participate in the innovation collaborative which included three learning workshops, action periods, monthly measures and support of the COV AUA project lead.  The piloted supportive living units participated in this group. 

Lower Sites/Units Group
LTC sites/units with 25% or less Antipsychotic QI from January to March 2014 were provided with information and resources throughout the implementation by the COV AUA project lead.

Outcomes

For January to March 2015, the average percentage of residents on antipsychotic medications for all COV LTC sites was 16% as measured by the Resident Assessment Instrument - Minimum Data Set (RAI MDS) 2.0 Antipsychotic Quality Indicator.  This is a 5% decrease from the same time period the previous year!

Through passion, dedication and commitment, sites/units have changed the culture of antipsychotic medication use and increased the awareness of person centre care, resulting in enhanced quality of care provided to residents with dementia.  Residents are once again enjoying the precious moments in their lives, recognizing and engaging with their loves one and participating in meaningful activities.

Limitations to the data for the total cost of antipsychotic medications were identified, therefore it was not possible to assess if a cost savings had occurred.  However, with the decrease in the percentage of residents on antipsychotic medication it seems most likely there would be a corresponding decrease in antipsychotic costs.
 
With the support of the COV AUA project structure, the innovation collaborative approach has contributed to the success of the AUA project. 

Recommendations

AUA Project

Continue to monitor the RAI MDS 2.0 Antipsychotic QI for change.  If above target, process is initiated to address the reason(s) for this change.

Monitor other indicators and outcome scales for change, as there may be unintended/intended consequences with changes in antipsychotic use.

Enhance the partnership in care of staff and families; further education and support are required for staff and families.

Expand the awareness and collaboration of team to include all staff and physicians, including therapeutic/rehabilitation teams, educators, and support services.

Provide ongoing tools and education to support the sustainability of the AUA project.

Increase awareness of the AUA page on CompassionNet and the AUA toolkit.

Future Project

Complete change management assessment prior to start of project.

For accountability purposes and to provide support to the project and the sites/units, expand representation on project committee to include more rural representation and corporate supports such as data and decision support, professional practice and quality improvement.

Improve access and utilization of computer technology (e.g. CLiC, SharePoint, Lync) to increase collaboration with provincial colleagues.

When developing the evaluation framework, ensure there is capacity to retrieve the specific data that is required.

To promote an environment of learning and sharing through collaboration, a similar implementation process (innovation collaborative approach, COV project structure) should be considered.

AUA Toolkit

The Alberta Guideline of the Appropriate Use of Antipsychotic Medications (2013) and accompanying resources provide health care professionals with direction regarding assessment and management of responsive behaviours associated with dementia.

To access the AUA Toolkit, visit the  Alberta Health Services website.

AUA Resources

Additional AUA Resources

COV AUA Sustainability Plan - Key Areas

COV AUA in LTC - Education Module

COV AUA in LTC - Education Module - Speaker's Notes

AUA Information Sheet for Families and Care Teams

Shifting Focus - A guide to understanding dementia behaviour

Dementia - Caring and Engaging Brochure

COV Policy VI-35  Therapy/Recreational Aid and Toy Cleaning

The Following Teepa Snow Videos Can Be Signed out From the COV Library

Filing the Day with Meaning

Teepa explains the difference between simple entertainment and engaging projects that stimulate brain activity; how to create engaging and affordable activities to give back moments of joy and happiness to patients/residents with special challenges, such as those with early onset dementia, tendencies for elopement, falls, and more; and which key activities to consider at different disease stages.

The Art of Caregiving

Learn how a person with dementia perceives his/her environment and understand unusual behaviors and memory problems; better strategies to offer help when the person with dementia does not seem to be aware of any changes or difficulties; Teepa's "Positive Physical Approach" to decrease the risk of distress; and about commonly occurring behaviors and recommended and preferred responses.