Quality use of antipsychotic medicines in residential aged care facilities in New Zealand
Henry C. Ndukwe 1 , Prasad S. Nishtala 1 , Ting Wang 2 , June M. Tordoff 11 School of Pharmacy, University of Otago, New Zealand
2 Department of Mathematics and Statistics, University of Otago, New Zealand
Correspondence to: Henry C. Ndukwe, School of Pharmacy, University of Otago, PO Box 56, Dunedin 9054, New Zealand. Email: henry.ndukwe@otago.ac.nz
Journal of Primary Health Care 8(4) 335-343 https://doi.org/10.1071/HC15054
Published: 21 December 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Antipsychotic medicines are used regularly or when required in residential aged care facilities to treat symptoms of dementia, but have been associated with several adverse effects.
AIM: The aim of this study was to examine ‘quality use’ of antipsychotic medicines in residential aged care facilities in New Zealand, by surveying nurse managers.
METHODS: A cross-sectional survey was mailed to 318 nurse managers working in a nationally representative sample of aged care facilities. A purpose-developed, pre-tested, 22-item structured questionnaire was used to explore practice related to the quality use of antipsychotic medicines.
RESULTS: Overall, 31.4% of nurse managers responded to the survey. They mostly (88%) had ≥ 1 year’s relevant work experience and 83% of facilities provided care for those within the range of 21 to 100 residents. Respondents reported that staff education on dementia management occurred early in employment. Two-thirds of participants reported non-pharmacological interventions were commonly used for managing challenging behaviours, while less than half (45%) cited administering antipsychotic medicine. Respondents reported ‘managing behavioural symptoms’ (81%) as one of the main indications for antipsychotic use. Frequently identified adverse effects of antipsychotic medicines were drowsiness or sedation (64%) and falls (61%). Over 90% reported general practitioners reviewed antipsychotic use with respect to residents’ target behaviour 3-monthly, and two-thirds used an assessment tool to appraise residents’ behaviour.
DISCUSSION: Staff education on dementia management soon after employment and resident 3-monthly antipsychotic medicine reviews were positive findings. However, a wider use of behavioural assessment tools might improve the care of residents with dementia and the quality use of antipsychotic medicines.
KEYWORDS: Quality use; antipsychotic medicines; non-pharmacologic interventions; challenging behaviour; adverse effects; residential aged care facilities
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