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Indicators & Change Ideas

Are you looking to improve the issues facing today’s health care system?

 

Explore the quality indicators being tracked by health care organizations in Ontario through Quality Improvement Plans (QIPs) and change ideas to help improve them. Connect with others to share your experiences and ideas of your own.

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Inappropriate use of antipsychotics

For residents of Ontario’s long-term care homes, antipsychotic medications may play an important role in managing the behavioural symptoms that sometimes occur with psychosis or dementia, such as agitation and aggression. But the use of these medications has sparked controversy across the province, the country and around the world because of side effects such as sedation, higher risk of falls and slightly increased risk of death. Family members of long-term care home residents may also see their loved ones struggling to communicate or sleeping for large parts of the day as a result of antipsychotic medication use. Without the drugs, however, some residents and their families might suffer because of behaviours that put them or others at risk.

Change Ideas

Identify improvement efforts planned or underway, including what resources and supports are available

  • Review the quality standard Behavioural Symptoms of Dementia
    Ontario Health Quality Standards
  • Explore opportunities to work with the home’s behavioural response team and champions
  • Consult with external teams, such as psychogeriatric resource consultants, Behavioural Supports Ontario, and seniors’ mental health services

Verify current resident data

  • Review the data from your home and pharmacy provider (indications, new starts, summary of responsive behaviours, interventions)
  • Verify the data on the number of residents prescribed antipsychotics, including new starts, prns, and administration rates
  • Request a medication-tracking tool from your pharmacist

Improve medication review process

  • Consider a team approach to quarterly medication reviews, involving physicians, pharmacists, and nurses
  • Use a standardized and simplified medication review process (see sample worksheet from Alberta Health Services)
    Pharmacologic Restraint Management Worksheet
  • Review the continuous use indicator at quarterly multidisciplinary medication reviews and summaries of resident recent behaviours, and identify residents who may benefit from trialing an adjusted antipsychotic use/dose

Update and implement individualized behaviour care plans

Choose optimal pharmacological interventions

  • Trial the lowest effective dose for the shortest duration. Monitor effectiveness and tolerability using the BSMT
    BEHAVIOUR AND SYMPTOM MAPPING TOOL (BSMT)
  • Check the Centre for Effective Practice’s Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide

Learn from your peers

Inappropriate use of antipsychotics

For residents of Ontario’s long-term care homes, antipsychotic medications may play an important role in managing the behavioural symptoms that sometimes occur with psychosis or dementia, such as agitation and aggression. But the use of these medications has sparked controversy across the province, the country and around the world because of side effects such as sedation, higher risk of falls and slightly increased risk of death. Family members of long-term care home residents may also see their loved ones struggling to communicate or sleeping for large parts of the day as a result of antipsychotic medication use. Without the drugs, however, some residents and their families might suffer because of behaviours that put them or others at risk.

Change Ideas

Identify improvement efforts planned or underway, including what resources and supports are available

  • Review the quality standard Behavioural Symptoms of Dementia
    Ontario Health Quality Standards
  • Explore opportunities to work with the home’s behavioural response team and champions
  • Consult with external teams, such as psychogeriatric resource consultants, Behavioural Supports Ontario, and seniors’ mental health services

Verify current resident data

  • Review the data from your home and pharmacy provider (indications, new starts, summary of responsive behaviours, interventions)
  • Verify the data on the number of residents prescribed antipsychotics, including new starts, prns, and administration rates
  • Request a medication-tracking tool from your pharmacist

Improve medication review process

  • Consider a team approach to quarterly medication reviews, involving physicians, pharmacists, and nurses
  • Use a standardized and simplified medication review process (see sample worksheet from Alberta Health Services)
    Pharmacologic Restraint Management Worksheet
  • Review the continuous use indicator at quarterly multidisciplinary medication reviews and summaries of resident recent behaviours, and identify residents who may benefit from trialing an adjusted antipsychotic use/dose

Update and implement individualized behaviour care plans

Choose optimal pharmacological interventions

  • Trial the lowest effective dose for the shortest duration. Monitor effectiveness and tolerability using the BSMT
    BEHAVIOUR AND SYMPTOM MAPPING TOOL (BSMT)
  • Check the Centre for Effective Practice’s Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide

Learn from your peers