Antipsychotics work is "the right thing to do," Revera VP says

Handling mechanical materials like nuts and bolts at his own work station, the resident is doing what he’s always loved to do. In the process, it’s significantly improved his behaviour – so much so that his wife was moved to tears. 

“She said it’s been so long since she had such a calm visit with him,” says Mary Brazier, Revera Inc.’s Vice-President of Quality and Support. “And it’s because we were able to deal with whatever that underlying issue was with the resident’s behaviours.”

The key was the Montessori approach utilized by staff to learn about the resident in order to create an activity of purpose and meaning for him, which then helps to manage some significant behaviours he presented. The success of this approach eliminated the option of prescribing antipsychotic medication for the resident.

This is one of the ripple effects of Revera’s participation in a national, year-long collaborative with 14 other organizations across Canada to reduce antipsychotics use among long-term care residents without a relevant diagnosis.

“We’re doing two things in tandem,” Brazier says.” We’re trying to reduce and take people off (of antipsychotics) but we’re also trying to enable a more holistic approach when dealing with behaviours.”

Increasing education about antipsychotics and expanding its Montesorri training to generate non-pharmacological care interventions are among some of the changes made by Revera since the Sept. 1 start of the collaborative, which is led by Canadian Foundation for Healthcare Improvement. 

The result has been an average six-per-cent reduction in antipsychotics use from 2013 at the 15 Revera homes participating in the collaborative, and Brazier says they’re on target for an average six-per-cent reduction this year too. Of their cohort’s 390 residents at seven Ontario and eight B.C. homes, 30 per cent are no longer taking antipsychotics and 45 per cent receive lower dosages.

These are some “great results,” Brazier says, with intrinsic value also emerging in the interdisciplinary approach and team focus on what is a key performance indicator for Revera. 

“One of our values is excellence and people are really starting to see that (non-pharmacological approaches) is the right thing to do for the resident,” she says, adding “when you think about quality of life then antipsychotics should be a last resort.”

“We had been doing quite a bit of work (around antipsychotics) leading up to the collaborative, and what I’m really excited about now is to pull all of our lessons learned from this project and all the things the homes found that worked the best and developing some guidelines to share with our homes (across Canada).”

A cornerstone of Revera’s collaborative work has been educating physicians, front-line and registered staff and families about the risks of antipsychotics and alternatives, Brazier says. This learning, coupled with the homes’ pharmacists completing more frequent and comprehensive reviews of residents’ medications, has opened up communication and the possibility for non-pharmacological interventions sooner, such as right at admission, and for more residents.

“Families have been hesitant, they’re afraid to change (when it comes to medication) because often it’s taken years to get their loved ones to a level to deal with responsive behaviours . . . and they’ve had to watch their loved ones go through changes,” Brazier explains.

“Education was really key and with that came much more cohesive collaboration across the whole care team, including families,” she says, adding they now know there are options to medication and they impact care by sharing their knowledge and observations.

Consistently engaging front-line staff in strategies like huddles to discuss changes in residents and their care has empowered them and enhanced teamwork.

Lastly, Brazier says, the collaborative’s frequent check-ins foster networking and knowledge exchange that is a “phenomenal support” for Revera’s homes. Participants share their successes and struggles, posing questions and offering different perspectives and solutions in the process.

“We get so entrenched in our own ways that we can’t see the forest for the trees and we need to be able to have those discussions,” Brazier says.

“It’s that quality improvement process of continually asking, “Why?’ to help us dig deep and get to the roots of things.”