In 2011, Wendy Calhoun, the then relatively new Managing Director of Vernon’s Creekside Landing, attended a workshop in Vancouver put on by the Tapestry Foundation. The foundation, which provides services for seniors in complex care, put on one presentation in particular that she found very interesting.
“One of the segments at the presentation was on decreasing use of anti-psychotic medication in the elderly,” said Calhoun.
She brought the information back to Creekside and took the initiative, along with the director of care who was also new at the time, to put together a plan to reduce the number of their own seniors on anti-psychotic drugs.
“It’s so easy to give them a pill, give them medication when we don’t truly understand the long-term effects of the drugs. We had to step back and educate staff on how we can do better to manage our residents when they have these episodes,” she said.
Tamara Ross, the Nurse Manager at Creekside, agreed with Calhoun that a change in approach was needed to match the ever-changing population in the facility.
“The reason we are reducing the use of anti-psychotics in this population is because of the increased risk associated with the use of these drugs,” said Ross.
“To measure the outcomes of our reduction efforts, we are looking much more long term. We will always be looking at poly-pharmacy in the elderly and the chance that the more medications our residents are on probably mean that many of them are cancelling each other out.”
Like many other senior care providers both in residential care and home support, Creekside, too, often finds that residents moving into their facility from acute care hospital beds are on anti-psychotic drugs upon admission.
“To fully address the use of anti-psychotic drugs in community care, we have to start with what is happening in hospitals and before the resident arrives at our door,” said Ross. “I have a lot of confidence that facility managers can reduce the unnecessary use of these medications and make sure families are active participants in the process.”
Now when residents and family arrive at the home, Creekside staff immediately assesses anti-psychotic drugs in association with medication reconciliation and medication reviews with the site’s general practitioner and pharmacist. Dr. Rick Sherwin, the Medical Director, has been an active supporter in developing Creekside’s strategy. He regularly completes reviews of anti-psychotics in addition to the resident’s individual care conferences, which also provides an opportunity to educate families and the resident about the medications.
Mandatory medication reviews are done every six months for each resident. Ross also holds quarterly medication safety and management meetings with the pharmacist and nursing staff to discuss a range of issues. The conversation includes best practice and current research on ways to properly reduce the use of anti-psychotics in the geriatric population.
“Recently we had several new admissions that have true psychosis, as diagnosed by our Geriatric Psychiatrist Dr. Francois Pretorius,” said Ross.
“In all cases where true psychosis is present and anti-psychotics are necessary, our nurses monitor the residents very closely and communicate behavior monitoring results to Dr. Pretorius. The need for the medications, in these cases, is reassessed when the psychiatrist visits every three weeks.”
Ross added that Pretorius, who also practices at Vernon Mental Health and Addictions, is completely on board with decreasing the use of unnecessary anti-psychotics in the population.
“He has done a lot to educate myself and the other nurses on the proper use of these medications,” she said.
Calhoun said although she is the managing director now, she came from humble roots.
“I started in 1982 as a care aide working on the floor. That has been a real bonus to have that skill to fall back on for insight, and I’ll never forget that’s where I came from,” said Calhoun.
Working in the industry for so long, she said it has often been status quo to use drugs and restraints to manage difficult behaviours.
“Medicating residents have been going on for years and years and years.”
Echoing her earlier statement of the need to “step back,” she emphasized the importance of careful care planning, brain storming and providing a lot more information on other resources that are available to help residents. She also said it was crucial that not only staff but also families get on board with this as well.
As a result of Creekside’s work over the past 12 months, they have successfully kept anti-psychotic drug use to under 30 per cent of residents — far below the average identified in the Ministry of Health 2011 report on the use of anti-psychotic drugs in British Columbia residential care facilities.
Creekside Landing is a long-term care facility that operates 70 residential care beds on behalf of the Interior Health Authority for frail seniors. The privately-owned facility is operated by Kaigo Retirement Communities, which also runs long-term care homes across the Okanagan and the Fraser Health Region. Visit www.kaigo.ca for more information. To download a copy of the Best Practices Guide for Safely Reducing Anti-Psychotic Drug Use in Residential Care click here.
– Written by freelance writer Benjamin Yong in part thanks to funding provided by WorkSafeBC.