October 2018

Change is happening at Beach Grove Home, the largest long-term care residence in Health PEI. It’s the same change that is happening at Labrador West Health Centre in Newfoundland and Labrador.

Care for people with dementia is moving toward a focus on the needs of the person and family, and reliance on certain medications is declining. Both are leading to a better quality of life for residents.

Across Canada, 1 in 5 long term care residents is on an antipsychotic without a diagnosis of psychosis. The drugs are often used to help manage behaviours related to dementia and overcome residents’ resistance to care. In direct response to the high use of antipsychotics, CFHI has worked with long term care homes across Canada over the last four years to improve elder care by spreading and scaling the appropriate use of antipsychotics approach (AUA).

Beach Grove Resident

A nurse at Beach Grove Home interacts with a resident who has benefitted from the appropriate use of antipsychotics approach.

The AUA approach is a person-centred care strategy that engages all members of interprofessional staff and families to co-design and co-implement personalized approaches to care. Empowered with better information about each resident, care teams can customize services to support residents.

This year, CFHI announced the implementation of the AUA approach in 39 homes in partnership with the Government of Newfoundland and Labrador and 9 in partnership with the Health PEI, building on work already underway in New Brunswick and Quebec.

“We are really excited about it, it is a great project, a great initiative” said Rochelle Visser, Nurse Manager at Beach Grove Home. “Obviously, the statistics show very clearly that deprescribing medications when they are not needed for our elderly is in everybody’s best interest. So we were very excited about the opportunity to gain the education from CFHI and also from the previous experience of the pan-Canadian collaborative.“

Beach Grove started their AUA journey in CFHI’s collaborative with workshops in March and April of 2018. The AUA collaborative supports staff in long term care (LTC) LTC through a variety of education, training and support activities. They include: monthly webinars, in-person workshops and education sessions, mentoring through coaching calls and site visits, sharing key resources, and facilitation of peer-to-peer learning opportunities. CFHI’s approach promotes sharing solutions and networking across regions and provinces. By May, Beach Grove was deprescribing antipsychotics for their residents when it was appropriate.

“There have been some challenges and learnings along the way,” Visser says. “But we have a really solid team, which includes a family member. He was a strong advocate for his wife when she went through the entire disease process. He is excellent – he translates what we are doing in common language.”

The excitement and positive thinking is also evident at Labrador West Health Centre where training began early in 2018. And for both teams, collaboration and the opportunity to learn from others has been key to early success. As has including as many people from their staff as possible, slowly adding more and more members to the team.

“Quite often we had discussed this issue, not only with antipsychotic medications, but also other medications in long term care,” said Corina Porter, Clinical Nurse Manager at Labrador West Health Centre. “I think the best thing we could have done was take our pharmacist with us [to training]. She has been on top of keeping track of everybody and their timelines, and where we should be and what we should be doing. She has been a phenomenal piece of that puzzle.”

The Beach Grove team has seen some early champions just naturally pop up as part of their project. For example, they have a dietitian on their team who noticed a change in two residents who had been deprescribed and who began enjoying their food again. Because of that, she connected with the project right away.

“We invite housekeeping and dietary staff to our weekly huddle on the unit,” says Rochelle. “This allows us to keep everyone in the loop.” For Corina, the participation of the wider multidisciplinary remains an important goal going forward.

“We definitely have the participation of our nursing staff,” adds Porter. “So far, if there is anything I could change it is that I would have liked to have more disciplines involved.”

Rochelle Visser quote Despite still being very early in their improvement journey, both teams are seeing early successes, with a several residents already having medications deprescribed. Along the way, they are learning a lot about how to support the residents and how to try non-pharmacological person-centred techniques to calm and care for residents. The bottom line? Both Rochelle and Corina are delighted with the progress to date. Their teams are coming together, engaging in opportunities to be part of the program and excited to already see the difference the program can make for residents in their homes.

“Everybody is really happy with the program. We’re doing our best, we are trying to provide resident-centred care. We use a lot of non-pharmacological approaches to care that were taught in the education classes with patients who aren’t even on antipsychotics and we’ve noticed a difference there,” said Corina.

“When you see a resident interacting in an environment having a better quality of life, it is noticeable to all the staff. It is a profoundly valuable thing in your heart,” said Rochelle.

The AUA collaborative is an 18-month province-wide program in all publicly-funded long term care homes in both PEI and Newfoundland and Labrador that is advancing the shared health priority of improving the appropriate use of prescription drugs. For more information visit: www.cfhi-fcass.ca/WhatWeDo/appropriate-use-of-antipsychotics.