Development of an effective educational framework to reduce antipsychotic use

Winnipeg Regional Health Authority (MB)

The Challenge

Antipsychotic medications are used to manage challenging behaviours in residents with dementia in long term care. Antipsychotics are costly, have significant adverse reactions and can reduce residents' quality of life. Their use in the Winnipeg Regional Health Authority (WRHA) personal care homes (PCH) averages 28 percent. However, 14 out of 36 PCHs have a utilization rate greater than 30 percent.  

The Improvement Project

The EXTRA project, “Using the Resident Assessment Instrument/Minimum Data Set to Promote Continual Quality Improvement in Personal Care Homes (Nursing Homes)”, demonstrated that intensive P.I.E.C.E.S™ education to nursing and support staff along with RAI-MDS reporting resulted in a reduction of antipsychotic medication use during the project period. Although this project showed a reduction in antipsychotic medication use, the current utilization rate is still above the targets identified in the literature (5-15 percent).

In order to produce a further reduction, our improvement project proposes to engage other team members including: physicians, nurse practitioners (NPs), pharmacists, residents and families. These team members are critical in the decision making process around antipsychotic medication use. Education modules will be built to create a comprehensive toolkit focused on the education needs of physicians, NPs, pharmacists and Residents/families. This would fill a current gap in the P.I.E.C.E.S™ curriculum. This toolkit could be translated to other PCHs and sectors such as acute care and community. Electronic delivery of the modules will facilitate broad distribution of the education regionally, provincially and nationally. Knowledge translation from the education modules into practice will be facilitated by support tools targeted at two team interactions – quarterly medication reviews and care conferences.