An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project.
BACKGROUND
This study evaluated a multi-faceted, interdisciplinary intervention to reduce the use of benzodiazepines and antipsychotics in nursing homes - the "RedUSe" (Reducing Use of Sedatives) project.


METHODS
The RedUSe project was a controlled trial conducted in 25 nursing homes in Tasmania, with 13 intervention and 12 control homes. A series of pharmacist-led strategies were provided to intervention homes including two medication audit and feedback cycles, educational sessions for staff and an interdisciplinary sedative review. Data on psychotropic drug use at each nursing home were collected utilizing a customized computer program at baseline, 12 and 26 weeks. The RedUSe project was registered as a controlled trial at the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12608000221358.


RESULTS
For each measure, an average of 1591 residents were audited. Over the six-month trial, there was a significant reduction in the percentage of intervention home residents regularly taking benzodiazepines (31.8% to 26.9%, p < 0.005) and antipsychotics (20.3% to 18.6%, p < 0.05), whereas control home psychotropic use did not alter significantly. For residents taking benzodiazepines and antipsychotics at baseline, there were significantly more dose reductions/cessations in intervention homes than in control homes (benzodiazepines: 39.6% vs. 17.6%, p < 0.0001; antipsychotics: 36.9% vs. 20.9%, p < 0.01).


CONCLUSIONS
RedUSe led to a significant reduction in the proportion of residents in nursing homes taking benzodiazepines and antipsychotics, and a significant increase in the number of dose reductions of these agents. Our findings suggest that a multi-faceted program, coordinated through a community pharmacy, can offer an effective approach in reducing psychotropic use in nursing homes.
Westbury
Juanita
J
Unit for Medication Outcomes, Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia. Juanita.Westbury@utas.edu.au
Jackson
Shane
S
Gee
Peter
P
Peterson
Gregory
G
D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D001569:Benzodiazepines / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004358:Drug Therapy / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use*
D014150:Antipsychotic Agents; D011619:Psychotropic Drugs; D001569:Benzodiazepines