In a Winnipeg long-term care home, data helped move the use of antipsychotic medications from being a first-line treatment to one of last resort.
The first sign that these drugs were perhaps being overused came from data gathered through indicators developed by interRAI, an international research collaborative, and supported for use in Canada by CIHI. Although regional use of antipsychotic drugs was in line with, or even slightly below, the national average, when staff at the Winnipeg Regional Health Authority looked at each of its 38 long-term care homes, the data showed that some homes were well above that average. Among them was Middlechurch Home of Winnipeg, where prevalence of use had reached 43%, compared with 30% across the region.
At the region’s Personal Home Care Program, Joe Puchniak, Manager of RAI/MDS and Decision Support, and Cynthia Sinclair, Manager of Initiatives, set out to help Middlechurch reduce its rate as part of their project work with the Canadian Health Services Research Foundation’s Executive Training for Research Application (EXTRA) program. The pair started educating all staff on a dementia care model which emphasized that medications were a last resort for behaviour issues.
Weekly mentoring helped staff develop care plans that looked for alternatives to medication. The following week, everyone would brainstorm about what had worked well and what hadn’t. Along the way, RAI data was regularly posted so all staff could see the results of their efforts.
Rates of antipsychotic drug use dropped more than 25% in six months among residents who were on them when the project began. Along the way, staff were empowered by the data and a desire to practise in a different way. Families are also happier their loved ones are on fewer medications, says Laurie Kuivenhoven, Middlechurch’s Executive Director. Since the project began, she hasn’t had a single complaint of loved ones being doped up.
Because the tools monitor many facets of care, the data also showed that there was no increase in behaviour issues or physical restraint use as medication use dropped. The potential savings are also significant: “If all homes were able to reduce to a target range of 5% to 10%, we’d probably be able to save $1 million a year,” Sinclair says.
Adds Puchniak, “With this project, we’re saving money and providing better care—how great is that? It really is data making a difference. You can’t say that enough. If we don’t use this data to make a difference, we’re missing an incredible opportunity.