Knowledge of and perceived need for evidence-based education about antipsychotic medications among nursing home leadership and staff.
OBJECTIVE
Antipsychotic use is common in US nursing homes, despite evidence of increased risk of morbidity and mortality, and limited efficacy in older adults with dementia. Knowledge, attitudes, and beliefs regarding antipsychotic use among nursing home staff are unclear. The study aim was to describe nursing home leadership and direct care staff members' knowledge of antipsychotic risks, beliefs and attitudes about the effectiveness of antipsychotics and nonpharmacologic management of dementia-related behaviors, and perceived need for evidence-based training about antipsychotic medication safety.


METHODS
Survey of leadership and direct care staff of nursing homes in Connecticut was conducted in June 2011. Questionnaire domains included knowledge of antipsychotic risks, attitudes about caring for residents with dementia, satisfaction with current behavior management training, beliefs about antipsychotic effectiveness, and need for staff training about antipsychotics and behavior management.


RESULTS
A total of 138 nursing home leaders and 779 direct care staff provided useable questionnaires. Only 24% of nursing home leaders identified at least 1 severe adverse effect of antipsychotics; 13% of LPNs and 12% of RNs listed at least 1 severe adverse effect. Fifty-six percent of direct care staff believed that medications worked well to manage resident behavior. Leaders were satisfied with the training that staff received to manage residents with challenging behaviors (62%). Fifty-five percent of direct care staff felt that they had enough training on how to handle difficult residents; only 37% felt they could do so without using medications.


CONCLUSIONS
Findings suggest that a comprehensive multifaceted intervention designed for nursing homes should aim to improve knowledge of antipsychotic medication risks, change beliefs about appropriateness and effectiveness of antipsychotics for behavior management, and impart strategies and approaches for nonpharmacologic behavior management.
Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester, MA. Electronic address: celeste.lemay@umassmed.edu.
Celeste A
CA
Lemay
Kathleen M
KM
Mazor
Terry S
TS
Field
Jennifer
J
Donovan
Abir
A
Kanaan
Becky A
BA
Briesacher
Sarah
S
Foy
Leslie R
LR
Harrold
Jerry H
JH
Gurwitz
Jennifer
J
Tjia
D000288:Administrative Personnel / Q000193:education; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003237:Connecticut; D003704:Dementia / Q000188:drug therapy; D055317:Evidence-Based Practice; D006801:Humans; D008503:Medical Staff / Q000193:education; D020380:Needs Assessment; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education; D011795:Surveys and Questionnaires
D014150:Antipsychotic Agents
Atypical antipsychotics; evidenced-based prescribing; nursing homes