Reducing the use of antipsychotics in long-term care: 1 facility’s journey

Deciding to place a loved one in a long-term care (LTC) facility can be a very difficult and emotional decision — especially considering that media reports tend to paint a grim picture of the quality of care delivered to Canada’s ailing population. One red flag that is often the focus of these reports is the use of antipsychotics in LTC homes.

In 2013–2014, about 1 in 3 (30%) residents in an LTC facility was potentially prescribed antipsychotics inappropriately, according to CIHI data available in the Your Health System: In Depth web tool. After looking at this data, the Canadian Foundation for Healthcare Improvement (CFHI), a not-for-profit organization dedicated to accelerating health care improvement in Canada, decided to take action.

In May 2014, CFHI launched Reducing Antipsychotics Medication Use in Long Term Care, a quality improvement collaborative to drive down the number of overmedicated residents. Interprofessional teams were assembled from 56 facilities across the country. CFHI provided each team with tailored education, customized coaching support and seed money (up to $50,000 per team), and actively worked with participants to reduce the number of residents on antipsychotics without a diagnosis of psychosis.

Reducing antipsychotics at Trinity Village Care Centre

Sharon Jackson, a behavioural support RN at Trinity Village Care Centre in Kitchener, Ontario, says the initiative not only has helped to improve the quality of life for residents but has also helped staff to create more meaningful relationships with patients.

Jackson already had her sights set on reducing the use of antipsychotics at the facility before she even knew of CFHI’s program. By the time she learned of the initiative from a colleague, she had just 24 hours to submit an application.

Once her facility had been accepted, she went to work at changing the practice. “I went into it with a ‘just do it’ attitude,” explained Jackson. “I wanted to put the plan in motion in all 5 units of our facility right away.”

The goal was to reduce the dosage of antipsychotics by 25% every 2 weeks for each of the 42 residents that were on the medication without a diagnosis of psychosis, until staff were able to discontinue dosing altogether.

“We tracked the behaviours and side effects of the patients, and found that most had no change in their behaviour with a reduced dosage once the side effects of the medication went away,” said Jackson.

In addition, as the residents became more alert and responsive off their medication, the nurses were able to better understand their needs and also to develop more meaningful relationships with the patients.

“The changes we’ve seen in our patients are incredible. We’ve had some patients who, before, never spoke or responded to anyone but are now social and seem very happy,” said Jackson. “One family told us they wished they had brought their loved one here years ago.”

Of the 42 residents who were part of the initial project, only 9 remain on antipsychotics (6% of the total number of residents, down from the initial 28%) and only 5 of those residents are on their original dose.

How did they do it?

Jackson used the financial support available through CFHI to increase and promote the services offered by the behavioural support team, and to provide education to nurses in order to shift the “culture of prescribing” to find non-pharmacological solutions — such as techniques promoted by the internationally recognized Gentle Persuasive Approach — to treat and work with residents.

Everyone at Trinity Village Care Centre has been working diligently to reduce the number of residents on antipsychotics. In most cases, residents initially enter the facility on the medication without a diagnosis. Looking forward, staff hope to use their experience and skills to educate other care providers in retirement homes and adult day programs to prevent the problem before it begins.