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REDUCING ANTIPSYCHOTICS IN DEMENTIA RESIDENTS

REDUCING ANTIPSYCHOTICS IN DEMENTIA RESIDENTS. IMPROVING SUCCESS Michael Preston, PharmD Director of Professional Relations Preston Pharmacy 2622 W Central Ave, Suite 302 Wichita, KS 67203 Date of Presentation: 12/13/2013.

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REDUCING ANTIPSYCHOTICS IN DEMENTIA RESIDENTS

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  1. REDUCING ANTIPSYCHOTICSIN DEMENTIA RESIDENTS IMPROVINGSUCCESS Michael Preston, PharmD Director of Professional Relations Preston Pharmacy 2622 W Central Ave, Suite 302 Wichita, KS 67203 Date of Presentation: 12/13/2013

  2. I. Know what you are up against A. Percentage of residents receiving antipsychotics B. What are the listed diagnoses C. What symptoms are being treated 1. Do they have significant psychotic symptoms 2. Is there truly potential harm to self or others a. Good examples b. Poor examples

  3. Psychotic symptoms 1. Frightening hallucinations 2. Distressing delusions 3. Panicking paranoia

  4. II. Meet with administrator and director of nursing A. Review goals B. Review expectations C. Review what is seen by diagnoses and numbers

  5. III. Meet with medical director A. Discuss expectations B. Discuss goals C. Inform of increased staff training 1. Work to find underlying issues 2. Work on non-pharmacological interventions 3. Staff are to understand caring for dementia residents to expect challenges

  6. IV. Letter to all providers A. Noting staff will be working diligently with non-pharmacological interventions B. Staff will be looking for underlying problems

  7. V. Letter to families A. Staff working diligently with non-pharmacological interventions B. Staff looking for underlying causes of problems

  8. VI. Staff education with inservices A. Typically challenge for culture change B. Will find allies C. Will find resistance D. Quote controlled, blinded studies 1. Again and again show lack of usefulness 2. Many serious side effects

  9. VII. Antipsychotics create huge amount of work with marginal benefit occasionally A. Think about increase cardiovascular events, MI and CVA, falls, 13 x more incontinence, increased confusion

  10. VIII. Example 183 bed facility A. Invited to consult B. Non-discriminating resident acceptance C. Started at 43% of residents receiving antipsychotics D. Currently at 18%

  11. IX. Antipsychotic committee A. Behavior monitoring followed here B. Interventions followed here

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