Halting Antipsychotic use in Long-Term care

1. Nursing home staff, GPs and pharmacists will undergo education and academic detailing on best practice in prescribing antipsycyhotic medications in older people and non-pharmacological approaches to managing challenging behaviours. GPs will undergo approximately 6 hours of academic detailing which will be accredited by the Royal Australian College of General Practitioners as a Clinical Audit attracting 40 CPD points. This will include a predisposing activity, approximately 3-4 hours total face to face time and evaluation activities at 6 months post detailing. In the instance that a GP does not require the CPD points and declines to undertake the RACGP activity, they will instead be offered a reimbursement of $25 for the time invested in attending to study tasks involving their patient. Pharmacists will undertake similar activities including a Group 2 continuing education module (8 points) accredited through the Pharmaceutical Society of Australia and the supply pharmacists will also be given the opportunity to undertake a Drug Use Evaluation activity (Group 3). 1 or 2 Registered Nurses at each participating nursing home will be given the role of "HALT Champion". These Champions will be the leaders of education and change within their workplaces. Their role will commence with a 3-day face to face workshop on person centred care, behavioural and psychological symptoms of dementia (BPSD) and how to manage these symptoms using non-pharmacological approaches. This workshop is interactive and provides practical strategies for implementation in the workplace. This education takes a "train the trainer" approach and following this workshop Champions will train the other care staff within their facility. They will do this using mini-tutorials at shift changeover (10 minutes), memo-cards, sharing of educational resources and at team meetings. The whole training process will take approximately 2 months and the aim of HALT is to have these new approaches to managing BPSD integrated into the culture of each nursing home resulting in sustained implementation of these strategies. Training of nursing home staff will be completed prior to the commencement of deprescribing. 2. Nursing home residents taking antipsychotic medications such as Risperidone, Haloperidol, Quetiapine and Olanzapine to manage Behavioural and Psychological Symptoms of Dementia will be identified and with agreement from their GP these medications will be deprescribed over a period of up to 3 months. Deprescribing protocols will be established for each resident participating in the trial by their GP and research pharmacist. Each dose reduction will take place at least 2 weeks apart until the drug is completely withdrawn.