Speakers
Description
Background:
Older adults with dementia residing in long term care homes (LTCHs) often exhibit behavioural and psychological symptoms of dementia (BPSD) such as agitation and wandering. Antipsychotics are often used to manage these behaviours; when prescribed without a diagnosis of psychosis, this constitutes inappropriate use and is linked to risks such as falls and death. The rate of potentially inappropriate antipsychotic use for 2024 at King Nursing Home (KNH) was 24.5%. The Canadian Institute for Health Information (CIHI) recommends a target of 15% for the use of antipsychotics without a diagnosis of psychosis. This project aims to reduce the inappropriate antipsychotic use at KNH from 24.5% to 15% by December 2026.
Methods:
A nonrandomized time interrupted study was conducted using the Institute for Healthcare Improvement (IHI) Model for Improvement. A multi-intervention strategy was developed targeting the root causes contributing to the local problem and in alignment with RNAO Best Practice Guideline on Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition. The interventions included improving application of non-pharmacological approaches to behaviour management, addition of a documentation alert to electronic health record (EHR), enhancing the accessibility and accuracy of documented resident care preferences, and building awareness and engagement of families.
Results:
The project remains in progress, with various intervention elements undergoing testing and phased implementation in iterative cycles. After implementing the EHR alert, a sustained improvement has been noted in documentation of resident behaviours which is critical for deprescribing antipsychotics. Early findings suggest that a multi-disciplinary, resident and family-centered approach may support reduction in inappropriate antipsychotic use in LTC.
Lessons Learned:
• Operational feasibility is crucial – align solutions with current workflows, staffing models, and organizational priorities
• Culture as the basis for success – quality improvement and best practice implementation do not succeed based on tools alone
Author(s) Credentials and Title
Raman Sandhar, RN, BN (Hons), CIC; Infection Control Practitioner, William Osler Health System; MSc QIPS Candidate, University of Toronto
Poonam Sunger, RPN; BSO- Lead, King Nursing Home
What RNAO BPG or tool/toolkit is your abstract related to?
RNAO Best Practice Guideline on Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition
| Organization Name | William Osler Health System, University of Toronto, King Nursing Home |
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