None listed
Conditions
Brief summary
For over thirty years research has consistently shown that the use of sedatives (predominantly antipsychotic and benzodiazepine medication) in many residential aged care facilities (RACFs) is excessively high. These agents only offer modest effects, yet are associated with significant adverse effects such as falls, confusion and daytime drowsiness, and they increase the risk of stroke and death. Many strategies have been adopted to reduce sedative prescribing in aged care. The most effective interventions involve audit and feedback, health practitioner training and medication review. Combinations of these strategies appear to offer the most success. The strategies of audit cycles, nursing staff training and ACF medication review are currently promoted and funded by the Australian government; however, there has been limited training for pharmacists to effectively deliver them. Further, there are no coordinated audit/training/medication review packages that specifically target sedative prescribing. The initial ‘Reducing the Use of Sedatives’ (RedUSe) project was a 6-month controlled trial conducted in 25 Tasmanian ACFs during 2008/2009. RedUSe was pharmacy-led and involved a computerised clinical audit of sedative use. This information was then presented to each facility alongside an educational session on the appropriate use of these medications. The final component of the RedUSe project was a dedicated sedative review process which involved nursing staff, the GP and the reviewing pharmacist. The initial RedUSe project resulted in a significant decrease in the utilisation of sedative medication, an overall reduction in sedative doses used and the project was well received by participants. This study involves a significant expansion of the RedUSe project to a national sample of 150 RACFs, and is funded by the Australian Government as part of the second round of the ‘the Aged Care Service Improvement and Healthy Ageing’ grants fund. In this expanded RedUSe project the same format of sedative audit and feedback, an educational program for ACF nurses and carers, and a dedicated interdisciplinary sedative review will be followed. The overall RedUSe program will be enhanced by the involvement of collaborators; the National Prescribing Service MedicineWise, and the Pharmaceutical Society of Australia. The ultimate benefits for residents in ACFs following successful reduction in rates of sedative use should include increased mobility and alertness, decreased fall rate and an enhanced quality of life. Other interventions have also shown an increase in the level of staff satisfaction when sedative use is minimalised and we aim to evaluate these outcomes in the expanded RedUSe project.
Interventions
The RedUSe (Reducing Use of Sedatives) intervention is a multi-strategic inter-professional program for RACFs. The program aims to ensure the appropriate use and review of two specific classes of psychotropic medications, antipsychotics and benzodiazepines.
The program lasts for 6 months, commencing with a psychotropic audit of all resident's medication. The prevalence findings are presented to all staff at an interactive case-based group educational session, which is then followed by a targete
The RedUSe (Reducing Use of Sedatives) intervention is a multi-strategic inter-professional program for RACFs. The program aims to ensure the appropriate use and review of two specific classes of psychotropic medications, antipsychotics and benzodiazepines. The program lasts for 6 months, commencing with a psychotropic audit of all resident's medication. The prevalence findings are presented to all staff at an interactive case-based group educational session, which is then followed by a targeted psychotropic review process involving a pharmacist, nurse and the resident’s prescriber. The full program was delivered to all 150 participant RACFs for the a 6-month period. To begin with, psychotropic audit measures were taken at baseline and 3 months, with a final follow-up audit performed at 6 months. The audit was performed using a specially designed program which collected prescribing data from supply pharmacy packing programs. The data was validated by a nurse at each home and when de-identified, was re-checked by researchers. All Educational sessions were delivered by trained consultant pharmacists already providing services to the RACF (the pharmacists attended a one-day training program in a group). These two 1 hour educational sessions were held at the RACF location after the first audit (baseline), and again after the 3 month audit. At each educational session, all staff were provided with a printed set of guidelines, a workbook and were then asked to view a video on evidence-based psychotropic use in older people and finally, to also view a customised PowerPoint presentation when each RACF's psychotropic audit results were presented, along with didactic information about antipsychotic and benzodiazepine use in older people. Session 1 at baseline was more general but session 2 involved case-studies and more discussion between attendees. Before the first educational session, all attendees were asked to complete a validated knowledge quiz. The same quiz was offered to attending staff at the end of the second educational session. The psychotropic review process was then performed for each resident taking psychotropic medications after the education sessions were held, specifically at baseline and at 3 months. This process involved the consultant pharmacist (same one as gave the training) providing their written information on a form, followed by a recommendation from a trained 'champion' nurse (training for 4 hours as a group) and finally, the GP or prescriber read the form and acted on the information if the judged this necessary. Researchers were not able to access these forms as they contained identifiable clinical information and names of health providers.
Sponsors
University of Tasmania
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
60 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
All permanent residents of RACF whether they were taking medication or not.
Exclusion criteria
RACF residents in respite care or those receiving active palliation
Outcome results
None listed