title: Improvements in the prescribing of antipsychotics in dementia and psychogeriatric units in New Zealand.
abstract: Background Despite warnings of possible serious events, and reports of little benefit, antipsychotic agents are commonly prescribed in residential care for older people with dementia. A residential care provider (RCP) in New Zealand sought to examine and improve prescribing in some of their facilities. Objective To examine changes following a range of interventions implemented by a RCP to improve the prescribing of antipsychotics. Setting Thirteen dementia and psychogeriatric units in New Zealand managed by a RCP. Method An audit (n = 228 residents) was undertaken in thirteen dementia and psychogeriatric units in New Zealand in July-September 2011. A modified Best Practice Advocacy Centre (bpac(nz)) tool was used to examine antipsychotic prescribing, the administration of "when required" (PRN) antipsychotic doses and antipsychotic-related documentation (e.g. documenting of "target behaviour identified" and "need to monitor for adverse effects"). Prescribing for some central nervous system agents and fractures and fall rates were also examined. Some educational, managerial, environmental, recreational and resident-specific interventions were implemented post-audit. The audit (n = 233) was repeated in July-September 2013.
  
  
  METHODS
  (1) Number of residents prescribed and administered antipsychotics (2) Documentation of antipsychotic-related information in residents' notes. Results The administration of antipsychotics and prescribing of regular doses (±PRN) decreased about a quarter from 2011 to 2013: 50.4-38.2, and 49.1-36.5 % (ORs 0.60, 0.57 respectively, both p < 0.001), and prescribing for any antipsychotic dose (including PRN only) decreased: 60.5-50.6 % (OR 0.67, p = 0.003). Documenting of "target behaviour identified" significantly increased from 54.3 to 71.2 %, (OR 1.99, p = 0.017) and documenting of the "need to monitor for adverse effects" increased non-significantly (30.4-46.6 %, p = 0.098); both falling short of the 90 % goal set by bpac(nz). Benzodiazepine prescribing significantly decreased [39.0-25.8 %, (OR 0.59, p < 0.001)]. Conclusions Following a range of interventions, antipsychotic prescribing, administration and some related documentation improved in dementia and psychogeriatric units in New Zealand. Future studies should aim to identify the most effective of these interventions so they can be considered for implementing in similar settings.
authors.affiliation: School of Pharmacy, University of Otago, PO Box 56, Dunedin, New Zealand. june.tordoff@otago.ac.nz.
authors.forename: June M
authors.initials: JM
authors.lastname: Tordoff
authors.affiliation: School of Pharmacy, University of Otago, PO Box 56, Dunedin, New Zealand.
authors.forename: Nagham J
authors.initials: NJ
authors.lastname: Ailabouni
authors.affiliation: School of Pharmacy, University of Otago, PO Box 56, Dunedin, New Zealand.
authors.forename: Dorothy P
authors.initials: DP
authors.lastname: Browne
authors.affiliation: School of Pharmacy, University of Otago, PO Box 56, Dunedin, New Zealand.
authors.forename: Hesham S
authors.initials: HS
authors.lastname: Al-Sallami
authors.affiliation: Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Gray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D003704:Dementia / Q000188:drug therapy* / Q000628:therapy; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005852:Geriatric Psychiatry / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009520:New Zealand; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012114:Residential Treatment / Q000379:methods*
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines
keywords: Antipsychotics; Dementia; Elderly; New Zealand; Nursing homes; Older adults