clinical focus
T
argeting what drives the prescribing of sedatives is key to
changing those practices in aged-care homes, attendees
of Leading Age Services Australia’s national congress
have heard.
Dr Juanita Westbury, from the University of Tasmania, recently
presented the key findings from the RedUSe project, which
aimed to promote the appropriate use of antipsychotics and
benzodiazepines in Australian aged-care homes.
The RedUSe project was implemented in more than 150 agedcare homes from 2014 and, following an initial site visit, involved
audits of medication use based on community pharmacy data,
staff education sessions and a review plan.
Aged-care homes that took part in the project reported
a significant reduction in rates of antipsychotic and
benzodiazepine use.
Here, Westbury sits down with Aged Care Insite to discuss
the RedUSe training sessions, the reduction rates seen across
Australia, and whether the results stuck.
ACI: You looked at sedative use across 150 aged-care homes.
What did the data reveal about sedative use in Australia?
Chill with the
sedatives
Antipsychotics and
benzodiazepines offer limited
benefits with considerable
risks; an audit finds their
use can be curbed.
Juanita Westbury interviewed
by Dallas Bastian
JW: We don’t know what the current rate of use of sedative
medication is in aged care. I’m talking about for antipsychotics,
which are usually given to people with dementia for altered
behaviours, and also benzodiazepines, which are given for anxiety,
sleep disturbance and agitation. What started by doing a baseline
measure of use across 150 aged-care homes in six states and
the ACT. We found that 22 per cent of residents were taking
an antipsychotic every day. We also found that about the same
amount were taking a benzodiazepine every day.
We also looked at what we call as-required prescribing, and
that’s when this medication is charted to be used when someone
has a behavioural symptom or is extra agitated, or anxious. We
found that this as-required usage was quite high as well, especially
for benzodiazepines. When we look at the combined daily and
as-required use, we found that 54 per cent of our residents were
charted for either an antipsychotic, a benzodiazepine, or both
– every day or as required. So more than half our aged-care
residents are charted for a sedative medicine.
The first step of the project, after the initial site visit, was an
audit, followed by staff education sessions. What did that
training target, and what discussions did it help facilitate?
As part of the project, we got an educational consultant to come
in and help guide our education development. Instead of making
it guideline [driven] and academic, what we wanted to do was
make it as interactive as possible. The major thing the consultancy
company told us was that to change behaviour, or make a
significant difference, you have to look at what drives behaviour.
In this case, what drives the prescribing of sedatives. We tried to
challenge the perception that these medications are effective and
improve a resident’s quality of life.
The final step was a review plan. What did that involve?
The results of the audit were presented during the education.
We tried to get a pharmacist to have a look at all those
people taking sedative medication, and do a guideline-based
recommendation. Then the nurse at the facility commented on
that recommendation, whether they thought it was appropriate
to reduce or cease the prescription of the sedative. Those
recommendations then went to the resident’s GP, so it involved
26 agedcareinsite.com.au