Improving organisational culture in residential aged care can reduce the use of psychotropic medications among residents, a consultant pharmacist and researcher tells Australian Ageing Agenda.
Dr Mouna Sawan, a research associate at the Cognitive Decline Partnership Centre at the University of Sydney, said previous research indicated that interventions to reduce psychotropic medications in aged care were working, however not to “maximum effect.”
She and her research team developed and tested a new tool, known as the Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE), to evaluate the relationship between organisational culture and the prescription of psychotropic medicines.
The study, which was published recently in Research in Social and Administrative Pharmacy, involved 40 participants representing facility and visiting staff from eight aged care facilities.
“Our tool will help identify elements of culture that are not conducive to improvement in the appropriate use of psychotropic medicines,” Dr Sawan told Australian Ageing Agenda.
“Organisational culture is a significant part of the solution as it considers the context of the work environment, which influences how interventions are implemented in any organisation including residential aged care facilities,” she said.
PRACTICE aims to improve the uptake of interventions that lower psychotropic levels by diagnosing the aspects of organisational culture that are not ideal.
The tool does this by assessing:
- how measures designed to reduce psychotropic medicines are being used
- the attitudes of staff towards their work environment and how this shapes decisions around psychotropic treatment
- the reasons staff do not adhere to ideal practices within aged care facilities.
The research highlights that more needs to be done than just focusing on interventions to reduce psychotropic levels, Dr Sawan said.
“A more holistic approach to practice change is needed and this includes identifying and addressing elements of culture which hinder appropriate psychotropic prescribing.
“Evaluation of culture will assess on-site and visiting staff attitudes and beliefs towards the work environment and how interventions to reduce psychotropic prescribing are utilised,” Ms Sawan said.
In addition to the general practitioner and the resident, the prescribing of psychotropic medicine should involve other stakeholders such as facility staff and pharmacists, Dr Sawan said.
“The residential aged care facilities’ culture has bearings on what staff suggest to the GP and in turn, the GP’s prescribing decisions,” she said.
Trust and mutual respect among all staff involved in the prescribing process is also necessary to cease psychotropic treatments, Dr Sawan said.
“Improvements in residential aged care culture to achieve a reduction in psychotropic prescribing should be multi-pronged, multi-disciplinary, patient focused and an ongoing effort,” she said.
The next step is to further test and validate the tool for clinical practice, Dr Sawan said.
The research, Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE) tool: a development and content validation study, is available here.
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