Effect of an interdisciplinary educational program on antipsychotic prescribing among nursing home residents with dementia.
OBJECTIVE
To assess the effect of an interdisciplinary educational program in reducing the use of antipsychotics in nursing home residents with dementia.


METHODS
We conducted a longitudinal pilot study to test the implementation of a 7-month interdisciplinary educational program in a fixed cohort of residents with dementia receiving antipsychotics. The program included consciousness-raising, educational sessions, and clinical follow-up. Administrators, physicians, pharmacists, nursing staff, and personal care attendants were involved. The effect of the program was assessed over a 6-month period, in terms of the proportion of discontinuations and dose reductions of antipsychotics. Repeated measures for use of other psychotropics and restraints, frequency of disruptive behaviors, and stressful events experienced by nursing staff and personal care attendants were simultaneously assessed.


RESULTS
Among the 81 residents still present at the end of the program, there were 40 (49.4%) discontinuations and 11 (13.6%) dose reductions. No significant changes were found in the use of other psychotropics, the use of restraints, or in the number of stressful events experienced by nursing staff and personal care attendants. The frequency of disruptive behaviors decreased significantly over the 6-month period (p<0.001).


CONCLUSIONS
Our interdisciplinary educational program led to a substantial reduction in the number of residents receiving antipsychotics and to a decrease in the frequency of disruptive behaviors. Our findings suggest that implementation of recognized practice guidelines could be an effective way to target residents who might not benefit from antipsychotics or who may tolerate a dose reduction.
Monette
Johanne
J
Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada. johanne.monette@mcgill.ca
Champoux
Nathalie
N
Monette
Michèle
M
Fournier
Lynn
L
Wolfson
Christina
C
du Fort
Guillaume Galbaud
GG
Sourial
Nadia
N
Le Cruguel
Jean-Pierre
JP
Gore
Brian
B
D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003704:Dementia / Q000188:drug therapy* / Q000451:nursing / Q000523:psychology; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing / Q000379:methods; D004509:Education, Nursing, Continuing / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005851:Geriatric Nursing / Q000193:education; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000592:standards*; D009740:Nursing Staff / Q000193:education; D010348:Patient Care Team; D010865:Pilot Projects; D015397:Program Evaluation; D011792:Quebec
D014150:Antipsychotic Agents