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New tool assesses facility culture to help cut psychotropic drug use


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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3 Responses to New tool assesses facility culture to help cut psychotropic drug use

  1. Annemarie October 17, 2018 at 12:43 pm #

    Dementia specific education to all aged care staff would help with lowering the rate of antipsychotics prescribed for residents!

  2. Shane Anderson October 17, 2018 at 5:02 pm #

    Annemarie is right, properly trained staff for dementia care would greatly assist the residents and their families. In my experience my mother’s ‘behaviours’ were easily resolved with simple and loving talks, not staff telling her off for something she didn’t understand. They started getting her to help make beds to give her something to do but when she started doing it herself they yelled at her, then called it wandering into other residents’ rooms. Then gave her anti-anxiety pills. I pointed out that they had taught her that behaviour in the first place, then sat with Mum for a while and told her that she could not go into other resi’s rooms and she stopped immediately.

  3. Anonymous for fear of reprisal October 30, 2018 at 1:27 pm #

    Going back to Dementia specific units would help rather than mixing non dementia residents with those suffering dementia. More truthfully, non dementia residents clash with those with dementia because of their intrusions and behaviours directed at non dementia residents and has dramatically increased workload.
    In the days of dementia specific units, the residents happily wandered freely and were catered specifically with diversionary therapy with much better outcomes. However having safe areas outside to walk freely and individuallly planned activities to reduce/eliminate behaviours, especially during sundowners avoids the need for regular or prn medication.

    Written by a long experienced aged care nurse who does care!

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