CARE TALKS Sustaining Practice Now That The Project Is ‘Officially’ Over
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Some History The Unit • 75 Long Term Care Beds • June 2013: 26% use of inappropriate antipsychotics (1/3 of the unit population) • Joined the Alberta Health Services Early Adopter Group due to high use (over 20%) • January 2014: 100% reviewed with an anti- psychotic rate of 15% • To date: 100 % reviews completed with a antipsychotic rate of 8%
Issues and Concerns • Many of the residents were non- communicative and drowsy • Increased use of large Broda-type chairs • Poor on-going assessment of need, antipsychotics automatically reordered when review due • Antipsychotics were requested immediately by staff for all types of responsive behaviors particularly on Evening shifts
Project goals • To review each resident on antipsychotics monthly. • To decrease to the point of discontinuation antipsychotic medications. • To educate staff about responsive behaviours and non pharmacological interventions. • To educate families about antipsychotic medication and inform them of this project.
Successes • Immediate drop in the number of antipsychotics used and prescribed • Two successful discontinuations of medications with no negative resident outcomes • Residents with discontinued medications were more able to participate in their care • Positive support from physicians and families
How do we stay the Course? Two levels of support and actions were required: 1) Locally at the site 2) Organizationally
How do we stay the Course? Locally • Celebrating and communicating our successes was essential • Education and leadership - mentoring was essential • The stories and the residents themselves offered the most motivation to keep going • Our Motto: DARE TO TRY
How do We Stay the Course? Organizationally • CapitalCare Strathcona shared our resident stories with our organization in our People and Progress newsletter and in organizational meetings with our actual statistics. • We began our own internal AUA collaborative supported by AHS and Lead by one of our executive .
How do We Stay the Course? Organizationally • Our policies reflect the need for staff to know and under s tand how to respond to folks with responsive behaviours. • Policies are being updated to clearly articulate best practice related to the use of antipsychotic medication with the elderly particularly those with dementia. .
What Have We Learned? • What gets measured gets done. • Clear communication about the goal and on- going conversations with staff and families is essential. • Start slow with a couple of easy interventions that will be successful. • Leadership is key and a team commitment is required - everybody has to try. • Always bring it back to the residents and how they are benefiting.
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