Work needs to be done to reduce antipsychotic drug rate, N.B. nursing homes association says
CBC
The head of the New Brunswick Association of Nursing Homes says having national data on the use of antipsychotic medication in long-term care homes without a diagnosis of psychosis will help lower the province's rate.
On Wednesday, CBC News reported that data from the Canadian Institute for Health Information (CIHI) shows 30.3 per cent of nursing home residents in New Brunswick were given antipsychotic drugs under "potentially inappropriate" circumstances in 2020-21.
That's the third-highest rate in the country. The national average is 22 per cent, based on data submitted by more than 1,300 nursing homes across Canada, or about 65 per cent of all homes.
"This was the first time that we saw our data compared to other provinces," association CEO Julie Weir said. "So step one is knowing where we stand, and step two is coming up with a plan to address those areas so that we can provide better care.
"So ... in talking with the homes, I said to them, 'Today is Day Zero. Now we know where we stand and we know what we need to do. So we just need to make a plan to get it done.'"
Antipsychotics are usually used to treat hallucinations, delusions, schizophrenia and Huntington's chorea disease, as well as for end-of-life care.
But these tranquilizers are also often used off-label — meaning they're not medically approved or recommended by Health Canada — to manage behaviour in residents with dementia, such as agitation or aggression. While there are some legitimate off-label uses, experts agree that the high rates require a closer look.
Cecile Cassista, executive director of the Coalition for Seniors and Nursing Home Residents' Rights, has suggested that nursing home staff shortages during the COVID-19 pandemic are behind the high rates.
But Weir contends that's "counterintuitive to what is the truth."
In 2016, when the province launched the Appropriate Use of Antipsychotics Collaborative to reduce the use of antipsychotics in nursing homes — and residents were weaned off the drugs or their doses were decreased — staff discovered they required less care and time, Weir said.
When residents were on the drugs, they were often sleepy, less responsive and required assistance with their meals, and with being transferred between their bed and chairs, for example, she said.
After use of the drugs declined, they were more participatory in their care, she said. "We saw that very, very clearly."
During that initiative, a collaboration with the then-Canadian Foundation for Healthcare Improvement, which is now Healthcare Excellence Canada, New Brunswick nursing homes reduced the inappropriate use of antipsychotics by more than 50 per cent in 2016-17, Weir said.
This was accomplished in part by educating staff on "person-centred" approaches to care, taking into account the preferences of residents, focusing on their strengths and compensating for their losses, she said.
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