A national, interdisciplinary intervention program designed to more appropriately manage sedative use is leading to significant reductions in the use of antipsychotics and benzodiazepines in residential aged care, initial results show.
The program, known as RedUSe, or Reducing Use of Sedatives, was developed by researchers from the University of Tasmania (UTAS) and involves facility staff, pharmacists and GPs to reduce the inappropriate use of antipsychotics and benzodiazepines within residential aged care.
The program, funded by the Department of Social Services, was rolled out nationally in 2014 following successful trials in Tasmania. By 2016, 151 residential aged care facilities will have participated in the program.
Preliminary results from data collected from 77 facilities, or around 6,200 residents, show significant reductions in antipsychotic and benzodiazepine use, with the percentage of residents using each sedative falling by 10 per cent and 20 per cent respectively.
Some 40 per cent of residents who had been taking sedatives at the start of the program had their sedative use either ceased or dose reduced by the time the six-month program was completed.
Lead on the project, Juanita Westbury, senior lecturer in Dementia Studies at the Wicking Dementia Research and Education Centre at UTAS, said the initial results were heartening and suggested RedUSe’s interdisciplinary approach was one of the more effective ways to manage the use of sedatives.
Dr Westbury will present on the findings at the upcoming Australian Association of Gerontology Conference in November.
“There is a real variation in the response, but when the three groups work together and recognise that everyone plays a part in ensuring appropriate care, you can really achieve some very good results,” she told Australian Ageing Agenda.
“It is a modest change but we think that gradually over time it will continue to reduce. Change is incremental… it’s like losing weight, if you lose weight too quickly, you usually regain, but sustained change occurs in small incremental steps.”
For Dr Westbury, the focus of the RedUSE project was not to suggest that providers should not use antipsychotics or benzodiazepines, but to encourage review of their use and dosage levels.
“We’re not advocating a complete restraint-free environment, but we’re advocating that people are taking this when needed and when appropriate,” she said. “People may be prescribed them perfectly appropriately when they’re coming in and showing symptoms, but they’re not being taken off them.”
Dr Westbury said she had been encouraged by the enthusiastic response from the industry about the project and the willingness of the professions to work together.
“The uptake from the aged care industry was great, especially considering this is difficult to do – it’s difficult to change behaviours and engrained cultural approaches,” she said.
The RedUSe program took place in three stages, repeated three times across the six-month period. The first stage was a clinical audit of a facility’s benzodiazepine and antipsychotic use. This was followed by an educational session for facility staff, led by the pharmacist who provided quality use of medicines service. These education sessions emphasised alternative methods to sedatives and a resident-centred care approach.
“We focus on looking at each resident as an individual and when they are aggressive or agitated, having a look at what could be causing that. Often it is unmanaged pain that they can’t talk about because their ability to express themselves can be impaired,” said Dr Westbury. “It’s also providing meaningful activities; it’s not just racing to a tablet. If they’re having trouble going to sleep, it’s giving them a warm hot drink, maybe talking to them for a little bit.”
After the education sessions, there was a sedative review process, where the sedative use of each individual resident was reviewed sequentially by a pharmacist, a specialised nurse and a GP. The intervention also encouraged resident and relative participation and involved educational visits to doctors.
Dr Westbury said the impact of the education provided was also apparent in initial results that found the use of sedating antidepressants and ‘as required’ sedative medication had also declined during the RedUSe program. This suggested that staff were not looking to substitute antipsychotics or benzodiazepines for other medications.
In the future Dr Westbury said she would like to see sedative use included in aged care quality indicators, RedUSe trialled in community care and the program’s length extended for further continuous review.
“That’s what continuous improvement really is. Keep an eye on it and if the level starts rising again, then you realise you need more education, more discussion and more focused attention,” she said.
The AAG National Conference takes place at Alice Springs Convention Centre from 4-6 November.
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