Appropriate Use of Antipsychotics Seniors Health SCN and Addiction and Mental Health SCN October 9, 2013 Acknowledgements I would like to acknowledge that some of the slides used today were developed by: Dr. Tom Noseworthy, VP/COO North Dr. Duncan Robertson, SMD, SH SCN Mollie Cole, Manager, SH SCN 2 Objectives To provide an overview of Strategic Clinical Networks To provide information on the mandate of the Seniors Health Strategic Clinical Network To provide an overview and project status report on the Appropriate Use of Antipsychotics in Long Term Care Project 3 1
What are Strategic Clinical Networks (SCNs)? Collaborative clinical teams (with a strategic mandate) Led by clinicians and driven by clinical needs Comprised of: Front-line physicians and clinicians from all professions (including primary care and community-based providers) Zone and other Clinical Leaders Primary & Community Care Researchers Content experts Public/ patients AH & other external partners 4 Why Clinical Networks? positive ways for clinicians, patients & partners to be involved in planning and improving care, service delivery along broad continuum effective mechanism for collaboration, joint decisionmaking & shared learning proven means of promoting the uptake of clinical evidence, knowledge, and research to reduce unjustifiable clinical variation and improve care research and innovation embedded (Scientific Directors and Research Networks within each) 5 Measure Quality and Promote Feedback for improvement any care path or treatment plan 2
Provincial Clinical Mandate Vehicle: Clinically driven change provincial in scope Performance measurement, research and best evidence driving practice Models of care & clinical care pathways Clinical variance measurement & management Engine: Strategic and Operational Clinical Networks 7 Triple Aim Consistent with Triple Aim (IHI) Improving the patient experience of care, including quality & satisfaction Improving the health of the population Reducing the per capita cost of health care 8 Current clinical networks Strategic Clinical Networks Seniors Health Addiction and Mental Health Bone and Joint Health Cancer Cardiovascular Health and Stroke Obesity, Diabetes and Nutrition Operational Clinical Networks Respiratory Critical Care Emergency Surgery 9 3
Seniors Health Strategic Clinical Network Antipsychotic Medications in LTC What is all the fuss? Appropriate use of antipsychotics Treatment for: mental health conditions (schizophrenia) hallucinations and delusions (part of psychosis) Little evidence of effectiveness for many behaviours associated with dementia: resistance to care calling out wandering/exit seeking 12 4
Hazards of Antipsychotics Recent research indicates increased adverse effects with long term use in those with dementia: Decrease in cognitive function Decreased ability to engage Mobility impaired increase in falls Metabolic implications Strokes Mortality (death) Increasing public concern internationally 13 Key Outcome and Deliverables of AUA project Reduce the use of antipsychotic medication in LTC AUA Clinical Practice Guideline and Toolkit of Resources to Manage Responsive Behaviours Key Performance Indicator: RAI 2.0 indicator on the use of antipsychotic medication without there being an indication of psychosis 14 Our Key Performance Indicator Target: Provincial Target of 20% by March 2018 (A five year target) 15 5
Updated September 26, 2013 Appropriate Use of Antipsychotics (AUA) Project Organization Effective September, 2013 SCN Executive Seniors Health SCN Core Committee Addiction and Mental Health SCN Core Committee Seniors Health SCN Project Sponsors Addiction and Mental Health SCN Project Sponsors Provincial AUA Steering Committee SH SCN Manager Project Manager SH SCN Practice Lead Project Working Groups AUA Clinical Guideline Expert Advisory Group ** Toolkit of Alternatives to Manage Responsive Behaviours Outcomes Evaluation **A subgroup of the EAG has been involved as the expert panel in the Alberta Health/AHS decision process for antipsychotic use in LTC and may be reconvened by AH at a later time in the process. AUA Guideline draft Will be online Alberta AUA Guideline to be based on BC (2012) assess the behaviour treat underlying cause try non-pharmacologic alternatives Prescribing resources involve family/alternative decision maker monitor (medication reviews) Decrease/discontinue medication resources 17 AUA Toolkit draft Will be online Aligns to AUA Guideline Behaviour maps/assess frequency/severity Assessment tools Prescribing information Family information guides Medication review steps Withdrawal protocols 18 6
Good Samaritan: Southgate Early Adopter Sites North Sector Extendicare: Athabasca South Sector AHS: Rimbey Covenant: Youville Capital Care: Strathcona Good Samaritan: Southgate Covenant: Youville Revera: Bow-Crest AgeCare: Beverly Bethany Calgary Brenda Strafford: Bow View Bethany Care: Calgary Covenant: St. Michael s Revera: Riverview 19 Collaborative Learning Methodology 3 Learning Workshops June 2013/October 2013/Feb 2014 Use score-cards to monitor progress monthly on 6 indicators 2 required : appropriate (medication review process) efficient (reduction in med use) 4 determined by site: chosen from a suggested menu of indicators: restraint use; pain, involvement of family, staff education, falls, behaviours 20 Teams choose indicators a menu of suggestions provided 7
Success in the Sites Supportive Leaders Regular team meetings to plan next steps in reducing medication use Involve the whole team (inter-professional nursing, physician, pharmacist, HCAs, recreation therapy, etc.) Quality Improvement bulletin boards noted in the sites detailing aims and success for this AUA project Resident / Family engaged 22 Phase 3 Provincial Rollout Guideline and toolkit resources shared with all sites elearning modules Multiple presentations/kt strategies Tailor intervention strategy to need - sites with higher AUA use offered more support May use a 4 cohort approach: over 30%; 25-30%; 21-25%; under 20% Currently 38/170 sites are under 20% 23 Questions? Comments? 24 8