From early defence to last defence: Project shifts view, use of antipsychotics 

Sienna Senior Living is growing an initiative to lessen use of antipsychotic mediation among its long-term care residents.

“Our plan right now is to hold regional education sessions for all homes in June, and we’ll be using the success of the three homes to help teach the rest and to really spread the initiative across the organization,” Director of Quality and Process Improvement Joanne Iacono says.

It’s the latest step for Sienna Senior Living as it participates in the Canadian Foundation for Healthcare Improvement’s (CFHI’s) national collaborative on reducing antipsychotics use. Sienna piloted the project with 95 residents at its Camilla Care Community in Mississauga starting last September and has generated a 43-per-cent reduction in antipsychotics use. 

In February, Sienna took the project to 64 residents at two more of its long-term care homes in the GTA where reductions around 30 per cent have also been achieved.

Iacono says the project has not only reduced dosages but completely freed residents from the medication.

“We’re starting to now see some outcome changes with some of the residents,” she says, noting there are individuals who’ve become more vocal or are performing their own daily activities. 

Focused on residents receiving antipsychotics without a relevant diagnosis, the CFHI collaborative bolsters the Ontario long-term care sector’s efforts to manage challenging behaviours, such as aggression, without using medication. 

For instance, Iacono says the project “fits in beautifully” with the Behavioural Supports Ontario (BSO) work at Sienna. BSO is a provincial initiative to help enhance quality of life for seniors affected by dementia and other conditions that cause agitation.

Additional education has been made available to collaborative participants – a key component for Sienna as registered and program staff and physicians engaged in learning sessions about the use, risk and benefits of antipsychotics, how to identify potential candidates for reduction and how to take a systematic approach to reduction.

Participants in the collaborative are also learning from each other as well as experts from Canada and the U.S.

Iacono says the education puts effective tools in the hands of team members who are passionate about providing appropriate and effective care for each resident.

“When some team members entered this, they were hesitant and not sure that medication reduction is the best avenue,” she says. “They left the education session with a profound culture change in that they switched their mindset of medication as an early defence to medication as a last defence.”

In addition to shifting views of antipsychotics, team members are realizing the importance of regular and strong assessments of residents who have been prescribed the medication.

“We’ve found that a large number of residents who came in on the medication or were prescribed it during their stay with us needed (the antipsychotics) at the time for various behavioural issues,” Iacono says.

“What we find, though, is that as the dementia progresses, behavioural issues may change or lesson. . . This project is not about inappropriate prescribing because at the time the medication was prescribed it was needed” she says. “Our project’s main focus is re-evaluation of the residents’ current state and determining if the medication is still required; (it’s) constantly reviewing the risks of the medication versus the benefits.”

Joanne Dykeman, Sienna’s Executive Vice-President of Long-Term Care Operations, says the collaborative reinforces staff members’ knowledge and overall approach.

“Our care teams are very focused on resident quality of life and know first-hand the value of non-pharmacological interventions to meet the special care needs for elders living in our homes,” she says.

The positive outcomes, which are emerging across the 15-health-care organizations in Canada participating in the collaborative, have the potential to change the stigma surrounding long-term care – a central component of Sienna Senior Living’s own creed. 

“Changing that image is one thing we feel very strongly about and through leadership, quality improvement and demonstration of these strong outcomes, it helps us to do that we,” Dykeman says.

She commends the collective vision and leadership of CFHI and project leads like Iacono for enlivening change through a commitment to resources and knowledge sharing.

“This is part of the entire sector addressing and responding to our obligations but also learning from each other, networking and creating that strength in long-term care.”