Edmonton – May 16, 2016 – A shift in care delivery at several Good Samaritan care homes has resulted in dramatic results for residents with dementia. The attitude and approach of staff changed regarding resident aggressive behaviours. As a result, the pilot unit went from 26% to 10% of its residents without an appropriate diagnosis being on antipsychotic medication. The changes come after The Good Samaritan Society took part in a bold pan-Canadian initiative spearheaded by the Canadian Foundation for Healthcare Improvement (CFHI) to reduce the inappropriate use of antipsychotic medication among residents in long term care (LTC).
From 2014-2015, The Good Samaritan Society worked with support from CFHI to lower the number of residents on antipsychotics that weren’t appropriately prescribed. The goal being that within 12 months we would have 20% or less of our residents that did not have an appropriate diagnosis on an antipsychotic. We also intended that, through education and working with staff on person-centered care, there would be a more positive atmosphere on the unit.
“Antipsychotics are often used in patients with dementia to curb resistance to care and other challenging behaviours,” says Stephen Samis, Vice President, Programs, CFHI. “But we have found that they provide limited benefit and can cause serious harm and complications from overuse – especially falls, which ultimately lead to unnecessary visits to the emergency room. With this initiative to reduce use, LTC providers report improved care for residents and a better culture at their facilities. Most important, family members say they now have their loved ones back.”
After only one year, early results from a sample of 416 residents from the facilities show:
- 54% of residents had antipsychotics discontinued or significantly reduced (18% reduced; 36% complete eliminations).
- Among these residents:
- Falls decreased by 20%.
- Verbally abusive behaviour decreased by 33%
- Physically abusive behaviour decreased by 28%
- Socially inappropriate behaviour decreased by 26%
- Resistance to care decreased by 22%
Early results at The Good Samaritan Society include:
“The CFHI collaborative helped our organization do the planning and cast the vision for what would be needed long-term for this work to continue as part of the way we give care,” said Jane Graff, CFHI Project Lead at The Good Samaritan Society. “The collaborative provided guidelines and a framework that left room for us to develop processes and systems specific to our organization.”The Good Samaritan Society is well below average in both Alberta and British Columbia. It should be noted that the beginning of the CFHI initiative began at midpoint on the graph above, exactly where the lines dip downward.
Recent studies show that more than one in four or 27.5% of seniors in Canadian long term care facilities are on antipsychotic medication without a diagnosis of psychosis. If the results of the CFHI initiative were scaled up nationally, the first five years would see an estimated:
- 35,000 LTC residents per year would have their antipsychotics reduced or discontinued.
- 25 million antipsychotic prescriptions avoided altogether
- 91,000 falls prevented
- 19,000 fewer emergency room visits (an 8% decline)
According to CIHI interRAI™ data, current antipsychotics rates within Alberta are at 21.1%.
| Potential Inappropriate Use of Antipsychotics in LTC – 2014-15 | |
| Canada – National Average | 27.5% |
| Alberta | 21.1%* |
| British Columbia | 31.2%* |
| Manitoba | Data Not Available** |
| New Brunswick | Data Not Available** |
| Newfoundland/Labrador | 38.2%* |
| Northwest Territories | Data Not Available** |
| Nova Scotia | Data Not Available** |
| Nunavut | Data Not Available** |
| Ontario | 27.3%* |
| PEI | Data Not Available** |
| Quebec | Data Not Available** |
| Saskatchewan | 31.3%* |
| Yukon | 27.5%* |
* Total provincial-territorial coverage for interRAI™ LTC data is available
** Total provincial-territorial coverage for interRAI™ LTC data is not available
Additionally, data shows that 5-15% of seniors in long term care facilities should be on antipsychotic medication, yet the national average is much higher.
“Decreasing the inappropriate use of these medications is only one part of the solution, we also have to shift the culture at the frontlines,” says Jessica Chisholm, Care Manger and CFHI Clinical Lead at The Good Samaritan Society. “We are working directly with the staff to show them they have more options than simply ‘giving a med’ to deal with these challenging behaviours, and it has been inspiring to see the great work they have accomplished.”
CFHI is calling for bold action across Canada to change the culture of overmedicating seniors with dementia and increase access to alternate programs. Through this collaborative, The Good Samaritan Society responded to this call to action and improved the care and health of residents, while also promoting the sustainability of the Alberta provincial health system.
For more information about this work:
CFHI Website:
http://www.cfhi-fcass.ca/WhatWeDo/reducing-antipsychotic-medication-use-collaborative
The Good Samaritan Society Website:
