CFHI Interview with Heather Daile Moffat, Vice President of Quality and Consulting Services, Sienna Senior Living, Ontario

June 2016

In an occasional feature, we interview leads of CFHI-supported projects. This month we profile Sienna Living about their involvement in CFHI’s Antipsychotic Reduction Collaborative.

Please describe your involvement with CFHI and its programs?

Sienna Living participated in an initiative related to antipsychotic reduction. We picked the care community that had the highest antipsychotic use in Sienna at that time based on the CIHI indicator data. Two consultants from our support services office attended a launch training session with CFHI prior to starting the project where training took place on all the available tools to support the planning, communication and launch of the project to incorporate an interprofessional team approach.

What improvement project is your team undertaking?

Our goal was to reduce by 30 percent antipsychotic use in people without a relevant diagnosis at our long term care site known as Camilla within one year, and to have no increase in behavioural issues. Initially 95 residents were identified as being potential candidates to have their antipsychotic medications reduced. In all, 41 residents had their medications discontinued and six other people had their medications reduced. This the project was further spread to our Streetsville and Cheltenham locations because of their willingness to participate. Both these sites used the same approach as Camilla. Streetsville obtained a 62 percent reduction from the 29 residents that were identified, Cheltenham obtained a 60 percent reduction among25 residents identified. We surpassed our goal and obtained an overall reduction rate of 54 percent across all three care communities.

What key challenge will your innovation solve?

The challenges to be solved include reducing the inappropriate use of antipsychotic medication in our care communities; fostering a collaborative process with the interprofessional team managing antipsychotic use; increasing the level of engagement for residents when the antipsychotic medication is reduced or discontinued; and spreading the project over time to achieve the desired results.

Barbara's Story

How does your innovation improve care for patients, families and caregivers?

This process strengthened inter-professional team collaboration, and obtained leadership buy-in from managers in the home and the attending physicians. Additionally, education in the homes among registered staff, program staff, and people working in the pharmacy helped build capacity and increased staff confidence. Members of the care team became part of the process and were able to have conversations with family members about the antipsychotic project. Today, care communities have indicated that family members find their loved ones more alert and responsive in conversations. Most families are grateful about the outcome of the discontinued medications after they saw the positive results and increased level of engagement.

Are there any cost savings that can be realized from your project? If yes, please describe.

Cost savings include a reduction in the medication used by residents, as well as time spent with residents who have negative effects from the antipsychotic medications they are taking, which results in more hours spent with a particular resident.

What has your experience been like working with CFHI?

We have had a very positive experience working with CFHI. The tools provided were easy to access and user friendly. The assistance provided to help deliver content to staff, physicians, pharmacist, family council and family members has been great.

What kind of support did CFHI provide to you and your teams?

From CFHI, we received training resources that included power point presentations, samples of how to start a dialogue with families about antipsychotic medications, and capacity building tools on antipsychotic medication.

What challenges did you encounter during the project? How were these challenges overcome?

Some homes were not as ready as others to participate in the collaborative. Sienna Living has had to work at getting buy-in among the care communities who were slow to get onboard with the antipsychotic reduction project. Also, while most families were grateful to see the medications discontinued, other families disagreed and did not want to participate as they believe the antipsychotic medications work well for their love one. Some families were also unable to understand post antipsychotic reduction symptoms and requested that the antipsychotic medications be restarted.

What feedback have you received concerning your project so far?

Our care communities have indicated that family members find their loved ones more alert and responsive to conversations once the antipsychotic medications have been reduced or discontinued. We have received very positive feedback from the interprofessional teams. The process for identifying candidates using quality indicators and assessment scores helped staff to really assess what is going on with the residents in their care. This helps the team decide who is the best candidate and gives good information to engage the physicians and pharmacist.

Do you have any results from your improvement project that you can share?

Initial results with the three care communities that participated show we surpassed our goal of a 30 percent reduction in the use of antipsychotic medications, and that we obtained an overall reduction rate of 54 percent. Overall, Sienna Living has continued to reduce antipsychotic use among people without a diagnosis of psychosis. Through our current quality improvement platform we continue to see successes in the antipsychotic reduction program. To date, 23 of 35 care communities are trending in a positive direction regarding reducing or discontinuing antipsychotic medications - ranging from 29 percent to 68 percent reductions over the last quarter. Across Sienna Living sites, all of our care communities are now using the CFHI tools to spread this beneficial project.

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