A-MOP: An Antipsychotic Medication Optimization Program for Long Term Care

1. A-MOP: An Antipsychotic Medication Optimization Program for Long Term Care Fiona Sudbury, RN, Director of Care Duncan Robertson , Chief of Medical Staff The Lodge at Broadmead Victoria, B.C., Canada

2. The Lodge at Broadmead

3. Population served Many Veterans 65% male Average age 88 50% admitted from hospital ALOS ~ 18 mos ~80% mod - severe dementia

4. Medication Optimization Program • Admission & regular review of medication • Beer’s list audits • Staff education and good practice guidelines • Policy development

5. Antipsychotic Concerns!

6. A-MOP Project Framework • Baseline descriptive statistics • Audit and clinical review • Make recommendations to prescriber • Develop new policy and procedure for antipsychotic drug use • Staff education and support • Ongoing quality monitoring

7. Atypical AntipsychoticUse - June 2011 – Time 1

8. Average Daily Dose

9. Audit Form & Clinical Review • RN audit: diagnosis, drug, dosage and frequency • Reason for use - behaviour of concern • Non-pharmacological strategies in care plan • Antipsychotic medication history • 3 month’s documentation of behaviour of concern • Review with Medical Coordinator or Geriatric Psychiatrist • Recommendation to primary care physician

10. Results - Time 1 Audits (N=62) • Indication for use: • 73% - Dementia (AD, VaD, Mixed) • 27% - Other psychiatric diagnoses • Rationale documented for 83% of residents • Most common reason - aggression and/or risk to self or others • Care plan review • 57% had non-pharmacological strategies identified • Medication history • 50% started lower than current dose

11. Impact of Recommendations to Physicians • 14 residents - drug discontinued • Of these, 7 prescribed PRN dose • 9 residents - dose reduced • 4 residents – no change advised • 3 residents - dose increased advised • 6 residents died before review completed

12. Comparison of Atypical Antipsychotic Use: T1 - T2

13. Project Successes • Clearer picture of atypical antipsychotic drug use in this care home • Increased team awareness of the risks and good practice principles for use of atypical antipsychotics • Pride in our apparently lower use than other care homes in our region

14. New Policy & Procedure • Prior to initiation: • Behaviour assessment • Treat causes of BPSD i.e. Pain, infection, depression • Care plan non-pharmacological interventions • On initiation: • Clear identification of behaviour of concern • Information and consent with family • Lowest effective dose • Ongoing monitoring: • Monitoring for effect and adverse effects • Review every 3 months • If no behaviour of concern, trial of dose reduction/withdrawal • Auto stop for PRN antipsychotics not used in 3 months • Quality monitoring of antipsychotic use Q 6 months

15. Final thoughts