title: Improving antipsychotic agent use in nursing homes: development of an algorithm for treating problem behaviors in dementia.
abstract: Many issues related to safety and quality care emerge from reports that nearly one in three nursing home residents is treated with antipsychotic medication, a rate that exceeds levels that led to nursing home reform more than 2 decades ago. Atypical antipsychotic medications have become the mainstay of treatment for behavioral problems among residents with dementia, despite federal "black box" warnings about health risks and research demonstrating their limited effectiveness. The purpose of this article is to briefly describe a dissemination research project designed to increase appropriate antipsychotic prescribing for older adults with dementia. A step-wise problem-solving algorithm designed to reduce unnecessary psychotropic medication use is described. Formative evaluation results provided by nursing home personnel are reviewed. Discussion focuses on nursing home culture as an important influence on the adoption of evidence-based practices and changes needed to promote use of behavioral interventions in dementia care and reduction of reliance on antipsychotic medications.
authors.affiliation: University of Iowa College of Nursing, Iowa City, IA 52242, USA. marianne-smith@uiowa.edu
authors.forename: Marianne
authors.initials: M
authors.lastname: Smith
authors.forename: Susan K
authors.initials: SK
authors.lastname: Schultz
authors.forename: Linda L
authors.initials: LL
authors.lastname: Seydel
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Reist
authors.forename: Michael
authors.initials: M
authors.lastname: Kelly
authors.forename: Michelle
authors.initials: M
authors.lastname: Weckmann
authors.forename: Michelle
authors.initials: M
authors.lastname: Weckman
authors.forename: Brian
authors.initials: B
authors.lastname: Gryzlak
authors.forename: Ryan
authors.initials: R
authors.lastname: Carnahan
mesh_terms: D000465:Algorithms; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy*; D004509:Education, Nursing, Continuing; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D009735:Nursing Homes / Q000458:organization & administration*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents