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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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Percentage of LTC residents not living with psychosis who were given antipsychotic medication

In Ontario long-term care homes, antipsychotic medications play a crucial role in treating behavioral symptoms, such as agitation and aggression, that are associated with psychosis or dementia. However, the use of antipsychotic medications has become a subject of controversy, both within the province and globally, due to their potential adverse effects, which include sedation, increased fall risk, and a slightly elevated risk of death. Family members of residents are often concerned when they witness these effects – loved ones struggling to communicate or experiencing prolonged periods of drowsiness – but, for some residents, not taking these medications can lead to behaviours that pose risks to themselves and others around them.

Key Resources

Change Ideas

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

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

Percentage of LTC residents not living with psychosis who were given antipsychotic medication

In Ontario long-term care homes, antipsychotic medications play a crucial role in treating behavioral symptoms, such as agitation and aggression, that are associated with psychosis or dementia. However, the use of antipsychotic medications has become a subject of controversy, both within the province and globally, due to their potential adverse effects, which include sedation, increased fall risk, and a slightly elevated risk of death. Family members of residents are often concerned when they witness these effects – loved ones struggling to communicate or experiencing prolonged periods of drowsiness – but, for some residents, not taking these medications can lead to behaviours that pose risks to themselves and others around them.

Key Resources

Change Ideas

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

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