Reducing unneeded antipsychotic usage a shared goal: McCarthy

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Recent media coverage isn’t telling the whole story, says OMNI CEO

Wednesday, April 16, 2014 — Deron Hamel

OMNI Health Care is involved with several initiatives to reduce the administration of antipsychotic medication in its 18 long-term care homes, says president and CEO Patrick McCarthy.

Recent media coverage of antipsychotic medication administration in long-term care homes is fair, he says, but notes reporters had the opportunity to delve deeper into their subject rather than scratching its surface.

McCarthy cites a front-page story in the April 15 Toronto Star that refers to Ontario long-term care homes “drugging helpless seniors.” McCarthy says this is hyperbole, but credits the Star for spotlighting an issue that deserves attention across the health-care spectrum, in hospitals, psychiatric settings, the community and long-term care homes.

The Star article, entitled “Use of Antipsychotics Soaring at Ontario Nursing Homes,” referenced Woodland Villa as having 65 per cent of its residents on antipsychotic medications without citing the source. The number of residents prescribed these medications currently is, in fact, 42 per cent. This is still above the 2012 provincial average of 31.5 per cent, but OMNI is working to continue to reduce the number of residents on psychotropic medications at all its homes through programs such as OMNI flagship programs Quality Matters and Supportive Measures as well as the province’s Behavioural Supports Ontario (BSO) initiative.

Other OMNI long-term care homes are significantly below the provincial average for psychotropic medication administration, McCarthy notes. For example, Garden Terrace has a rate of 18.9 per cent of residents on antipsychotic medications without a corresponding diagnosis. The number is 21.3 per cent at West Lake Terrace.  Residents may be admitted on antipsychotic drugs from hospital or other settings, and time is needed to carefully assess alternative medication or non-medication interventions that maintain safety.

In fact, Riverview Manor in Peterborough is an example of an OMNI home with a quality plan to reduce PRN (pro re nata, or medications prescribed as needed) antipsychotics.

“(OMNI homes) are working to reduce the (administration) of PRNs where non-pharmaceutical interventions are effective, as well as working with physicians and psychiatric outreach teams to reduce regular administration of the prescription pharmaceuticals,” McCarthy tells the OMNIway.

“The pharmaceuticals are often low dosages, and are assessed for effectiveness and reviewed with the prescribing physicians on a regular basis.”

The article points to the issue but doesn’t mention what OMNI and other long-term care operators are doing to curb antipsychotic medication administration.

“We are taking action on a daily basis, including benchmarking against the use of antipsychotics, and developing robust plans in conjunction with the doctors who do the prescribing so that we can manage the use of antipsychotics,” McCarthy says.  Residents and families are informed and consent obtained,  and resident care plans are reviewed on a regular basis, involving residents and families.

Behavioural Supports Ontario

BSO, a $40-million provincial initiative to enhance quality of life for seniors affected by dementia and other conditions that cause agitation, has been successful at several OMNI homes with embedded staffing.

In its first year of involvement with BSO in 2012, Riverview Manor saw a 35.5 per cent decline in responsive agitation, while the rate of PRN (pharmaceuticals given on an as-needed basis, which includes antipsychotics) medication administration dropped 34.4 per cent.

Likewise, Streamway Villa in Cobourg has reported a significant reduction in incidents of responsive behaviours, such as aggression, wandering, physical resistance and agitation, after team members began applying their BSO learnings.

The Star article paraphrased McCarthy saying he attributed “a nurse shortage” to contributing to “an over-reliance on drugs to handle elderly patients with dementia.”

McCarthy says he never mentioned “a nurse shortage” but rather told the Star there are more effective ways of allocating resources to address aggressive behaviours in long-term care homes.

Investing provincially in BSO staffing embedded in homes, and providing front-line staff with BSO training is one such way, he says.

“We have found that we have had positive results where we have had embedded staff from Behavioural Supports Ontario, in terms of the administration of antipsychotics and a better way for allocating funding across the system that better recognizes the issue of behaviours,” McCarthy says.

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