Quality Improvement Project: Reduction of Antipsychotic Use in Nursing Home Patients with Dementia

Abstract

Specific Aims: The purpose of the project was to determine if implementation of a detailed pharmacist recommendation form written for providers, could be an effective tool to reduce the use of antipsychotics in the psychiatric nursing home patients with dementia by 15%. Methods: The project was conducted by a pharmacy student and a consultant pharmacist at a single psychiatric nursing home. Thirty recommendations were written to the nursing home providers. The prescribers made comments on the forms and returned them to investigators for analysis. Active orders were compared pre and post pharmacy recommendations. Main Results: Of the 30 interventions, the prescriber addressed 26 (87%) recommendations and agreed to 15 (58%) of them. Nine recommendations involved either a GDR, discontinuation of a medication, or switching to a non-pharmacological method. Six of the nine (66%) recommendations led to the prescriber reducing the dose or discontinuing the medication. Overall, six out of 30 (20%) interventions resulted in a successful reduction of the use of antipsychotics. Conclusion: This project showed that when the prescribers see a more detailed pharmacist written recommendation regarding the therapy, they are more likely to respond with an explanation. However, even though the overall reduction was 20%, black box warnings did not seem to be a deterrent for prescribing in this psychiatric nursing home. Antipsychotics are heavily relied on to control behaviors associated with dementia.