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Long Term Care Leaders, Staff Still Behind Antipsychotic Learning Curve, Study Claims

ong term care providers are not up to date about the dangers of using antipsychotic drugs to treat dementia, according to a new study.

Canvassing leaders and staff of 68 nursing homes in Connecticut, researchers found that 56 percent of direct-care staff agreed with the statement that using such medicines to handle residents’ behavior “works very well.”

The findings were consistent across job titles: 54 percent of registered nurses, 56 percent of licensed practical nurses, and 57 percent of nurse assistants agreed with the statement, the researchers found.

Probing deeper, the researchers claim they found an alarming amount of ignorance about the dangers of antipsychotic medicines: only 18 percent of leaders and 3 percent of direct-care staff knew that the drugs can cause death; 4 percent of leaders and 2 percent of direct-care staff knew they can cause heart problems.

The researchers published their findings in the December issue of the Journal of the American Medical Directors Association. While acknowledging that their survey “had several limitations,” they nonetheless said that their findings show how much work the profession has to do to stamp out the needless use of antipsychotic drugs.

“Without knowledge of the potential harm that an elderly resident can experience as a result of receiving antipsychotic medications, it is difficult for prescribers to appropriately weigh the risks and benefits of prescribing these medications,” research leader Celeste Lemay wrote for her colleagues. “The implication is that intervention efforts to improve knowledge and beliefs about antipsychotic medications should target all levels of nursing home staff, including leadership and direct-care staff, with appropriate tailoring to meet the responsibilities of these diverse roles.”

Reform advocates have long targeted antipsychotics as a bane to quality care. The American Health Care Association has set an ambitious goal of having its members cut the off-label use of antipsychotics by 15 percent. Nearly half of AHCA’s Connecticut members have already achieved the goal, and the state was well ahead of national trends by cutting antipsychotic use more than 16 percent between 2011 and this year.

But the JAMDA study illustrates that more work lies ahead, says Ruta Kadonoff, AHCA’s vice president for quality and regulatory affairs.

“This study highlights one of the primary reasons in 2012 AHCA launched its Quality Initiative, which includes a goal to safely reduce antipsychotic use in nursing care centers,” she says. “Significant progress has already been made over the last two years and we expect that progress to continue. AHCA recognized the first step in driving such change is addressing the underlying attitudes and beliefs among some physicians and nursing center staff and has developed education and resource materials geared toward this.”

I agree with Wendy Walters. At our facility we have safely reduced the usage of these drugs. We have residents admitted with these drugs and no one can tell us why they were prescribed. Those of us that work in LTC are very aware of the dangers of these drugs. We are certainly not “mired in ignorance”. Just maybe the area you surveyed is – just a thought. The survey obviously did not cover enough facilities to get a good baseline.