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Collect and monitor current resident medication use data

• Review medication use data from the home and from pharmacy providers (e.g., indications, new starts, PRNs, administration rates, summary of responsive behaviours, interventions)
• Sign up for long-term care practice reports for antipsychotics data and change ideas for reducing the use of antipsychotic medications
  Ontario Health MyPractice: Long-Term Care

Establish a regular medication review process

• Use a simple, standardized medication review process
  Alberta Health Services: Pharmacologic Restraint Management Worksheet
• Upon admission of new residents, conduct a comprehensive assessment to determine if antipsychotic medications are being used and whether there is an appropriate diagnosis that justifies their use
• Consider using an interprofessional approach – involving behaviour support leads, physicians, pharmacists, nurses, and personal support workers – for monthly and quarterly medication reviews
• Review the charts of residents that trigger the RAI (Resident Assessment Instrument) Indicator Code: DRG01 to assess appropriate use of antipsychotics

Develop and update individual behaviour care plans

• For each resident, evaluate whether any potential contributors to behavioural and psychological symptoms of dementia are present (e.g., conduct an assessment for delirium, a general medical and mental health history, a pain assessment, a medication review, a substance use review, and hearing and vision assessments)
  P.I.E.C.E.S. assessment tool - A practical, effective approach to change and continuous improvement
• Use standardized assessment tools to inform care plans (e.g., Dementia Observation System, Cohen-Mansfield Agitation Inventory, Kingston Standardized Behavioural Assessment)
  Behavioural Supports Ontario Dementia Observation System
  Kingston Standardized Behavioural Assessment
  Cohen-Mansfield Agitation Inventory
• Incorporate nonpharmacological interventions into care plans for residents who are being treated with antipsychotics or displaying responsive behaviours
• Engage residents, families, and care partners in discussions about antipsychotic medications, responsive behaviours, and care with nonpharmacological interventions
  Distribute factsheets or information pamphlets
  Choosing Wisely Canada: Treating Disruptive Behaviour in People with Dementia: Antipsychotic drugs are usually not the best choice
  - How Antipsychotic Medications are Used to Help People with Dementia—A Guide for Residents, Families, and Caregivers
  Trial the lowest effective dose for the shortest duration. Monitor effectiveness and tolerability using the behaviour and symptom mapping tool
  -Behaviour and Symptom Mapping Tool

Collaborate with behavioural support and mental health services

• Explore opportunities to work with an external behavioural support lead, team or champion
  Consult Behavioural Supports Ontario or consult with a Geriatric Mental Health Outreach Team or a Psychogeriatric Resource Consultant

Improve staff education and training on dementia

• Educate staff on antipsychotic medications and the behavioural symptoms of dementia
• Train staff to use a person-centred, compassionate, gentle approach to responsive behaviours
  Advanced Gerontological Education’s fact sheet on About Gentle Persuasive Approaches in Dementia Care training
• Train staff to consistently complete necessary care plan documentation
• Implement protocols and clinical pathways that are in-line with best practice guidelines to clearly guide staff actions
  RNAO Best Practice Guidelines
  RNAO Clinical Pathways