Glacier View Lodge AntiPsychotic Reduction What We Wish

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Glacier View Lodge Anti-Psychotic Reduction

Glacier View Lodge Anti-Psychotic Reduction

What We Wish for Our Facility/Residents • Our residents deserve the best! Not just

What We Wish for Our Facility/Residents • Our residents deserve the best! Not just from a care perspective but also a medical one. Decreasing the amount of inappropriately used anti-psychotics improves our resident’s quality of life • Joining the CLe. AR initiative assisted us with improving our practice standards and gave us new tools and perspectives. It has supported us on an often difficult path of changing staff and family perceptions about the overuse of anti-psychotics, which in turn increases quality for the people we care for.

Team Aim • To enhance our resident’s quality of life by reducing the inappropriate

Team Aim • To enhance our resident’s quality of life by reducing the inappropriate use of anti-psychotics. Goals/Objectives: • Ensure appropriate indications for AP usage, including identifying target symptoms • Ensure timely medication reviews are occurring • Follow best practice standards • Enhance our skills in non-pharmacological behaviour management

Team Members • • Bev Powell Mya Ambrose Effie Warden Chloe Leopkey

Team Members • • Bev Powell Mya Ambrose Effie Warden Chloe Leopkey

Action and Improvement Team Photo From left to right: Bev Powell, Effie Warden, Mya

Action and Improvement Team Photo From left to right: Bev Powell, Effie Warden, Mya Ambrose, Chloe Leopkey

Team Information • Bev Powell: The Director of Care extraordinaire! • Mya Ambrose: Our

Team Information • Bev Powell: The Director of Care extraordinaire! • Mya Ambrose: Our brilliant, best dementia sensitive nurse in the whole world with oodles of knowledge! • Chloe Leopkey : Kind, compassionate, always looking for quality care • Effie Warden: Knowledge seeker who sometimes asks too many questions. . . .

Results • When we started in April 2013 an audit revealed that 59/101 residents

Results • When we started in April 2013 an audit revealed that 59/101 residents received an anti-psychotic. • Of those 59 residents, 48 did not have an appropriate diagnosis or indication for use. • Our first step was to review our resident’s history to determine why an anti-psychotic had been prescribed. . .

Results Continued. . . • The second step was to educate our physicians about

Results Continued. . . • The second step was to educate our physicians about the CLe. AR initiative and collaborate with them to ensure that when an AP was ordered, the diagnosis or indication for usage was appropriate and that target symptoms were identified. • Finally, buy in from nursing, care staff and families was fostered and remains the key to our success. • Currently 35 -40% of our residents receive an anti-psychotic. • We track aggression to ensure that our AP reduction initiative has not resulted in increased aggression. Our data indicates that 90% of our incidents are care related and we are addressing this with non rx interventions.

Changes Tested • The biggest change we tested was altering perceptions. A pill is

Changes Tested • The biggest change we tested was altering perceptions. A pill is always easier to give and takes far less time, but to truly be resident centred, we needed to use more nonpharmacological interventions. Some doctors, nurses, care aides and even family members felt that the “quick fix” was best. With time and effort, we are seeing the power of modifying the environment and decreasing stimulation in reducing unnecessary AP’s.

Changes Tested Continued • One of our biggest challenges to improving our “numbers” was

Changes Tested Continued • One of our biggest challenges to improving our “numbers” was the amount of new admissions we had. In a 6 month period we admitted 22 new residents. 59% (13)of those new admissions had anti-psychotics prescribed at time of admission. • Of the 59%, 23% had their anti-psychotics discontinued within 6 weeks of admission. • Anxiety was one of the major reasons for AP use. Adding, changing and increasing SSRI’s has helped greatly.

Lessons Learned • Use your whole team to assess residents need for AP usage.

Lessons Learned • Use your whole team to assess residents need for AP usage. The housekeepers and kitchen staff see many things nursing doesn’t. Everyone is an integral to success! • Communicate, communicate!! With family, physicians, staff and volunteers. By having everyone onboard, we see a clearer picture of what is working and what isn’t.

Lessons Learned Continued • Never give up. Some months it was frustrating because the

Lessons Learned Continued • Never give up. Some months it was frustrating because the amount of residents admitted on AP’s overshadowed the work we had done with existing residents. Don’t focus on the numbers – focus on the work. • Educate, educate!! The more we talk about improper use of anti-psychotics, the more the culture shifts towards proper use. There are so many people that have never heard the term “BPSD”. Keep everyone involved.

Next Steps • Continue to strengthen our ability to provide care that reduces behavioural

Next Steps • Continue to strengthen our ability to provide care that reduces behavioural triggers for reactivity. • Continue with regular med reviews, with a goal of polypharmacy and AP reduction. • Enhance our behavioural assessment skills to ensure that medications are appropriate to symptoms (ie. Treatment of anxiety=SSRI) • Build relationships with physicians, pharmacists, family and staff members to ensure the best team approach for care.

Facility Contact Info Glacier View Lodge 2450 Back Road Courtenay, BC V 9 N

Facility Contact Info Glacier View Lodge 2450 Back Road Courtenay, BC V 9 N 8 T 5 Phone: (250)338 -1451 Fax: (250)338 -1428 glacierviewlodge. ca