Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC. A multi component intervention to reduce inappropriate antipsychotic prescribing was evaluated in ten Canadian long-term care facilities.
Increasing numbers of older adults are affected by dementia, and many will eventually reside in long-term care (LTC), where antipsychotic use is relatively common. Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use. The objective of the study was to evaluate a multicomponent approach to reduce inappropriate prescribing of antipsychotics in LTC. A prospective, randomized stepped-wedge, study design was used to evaluate the effect of the intervention in 10 LTC facilities in Canada. The intervention consisted of an educational in-service, provision of evidence-based tools to assess and monitor neuropsychiatric symptoms (NPS) and monthly interprofessional team meetings.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Multi component educational intervention in long-term care
Percentage of long-term care residents receiving any antipsychotic without a diagnosis of psychosis
The proportion of long-term care residents receiving any antipsychotic without a diagnosis of psychosis is a quality indicator is used by the Canadian Institute for Health Information to determine potentially inappropriate antipsychotic use. The quality indicator is calculated using information routinely collected on Resident Assessment Index-Minimum Dataset (RAI-MDS) assessments by determining the number of individuals who received antipsychotics on one of more days in the 7 days preceding index (RAI-MDS item O4a ≥ 1). Individuals with schizophrenia, Huntington's disease, hallucinations, delusions, those with a limited life expectancy and those currently receiving palliative care are excluded from the numerator and denominator of this indicator.
Time frame: 12-months
Worsening of behavioral symptoms
Proportion of residents who had one or more of the following behavioural symptoms: wandering, physically or verbally abusive, or socially inappropriate behaviours) present on their target RAI-MDS assessment than on their prior assessment.
Time frame: 12-months
Use of physical restraints
Proportion of residents in daily physical restraints as of the target RAI-MDS assessment.
Time frame: 12-months
Depression: Proportion of residents whose mood from symptoms of depression worsened
Proportion of residents whose mood from symptoms of depression worsened compared to the previous RAI-MDS assessment.
Time frame: 12-months
Falls: Proportion of residents experiencing a fall in the 30 day
Proportion of residents experiencing a fall in the 30 days preceding the RAI-MDS assessment.
Time frame: 12-months
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Pain: Proportion of residents who had pain
Proportion of residents who had pain on their target RAI=MDS assessment.
Time frame: 12-months