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Hall & Prior Health & Aged Care Group (WA)

Mayfair St, West Perth WA

Reducing Risperidone Use in Dementia

Freshwater Bay Nursing Home, Mosman Park Nursing Home

Residential - Metropolitan - Multiple locations - 30 - 79 beds / consumers

Award descriptors

  • Clinical care/medication management
  • Dementia care
  • Health and wellbeing

Change in clinical practice and culture within homes to reduce the use of Risperidone as a first line pharmacological treatment for behavioural disturbances in dementia.

About this program

Risperidone is a psychotropic drug, which was approved for use in the treatment of behavioural and psychological symptoms in dementia where non-pharmacological interventions have failed. Although Risperidone was indicated as a second line treatment and had been documented to provide modest improvements in treatment, precautions for use were outlined in the Clinical Practice Guidelines and Principles of Care for People with Dementia. Clinical trials revealed the older people were more susceptible to adverse side effects, with a noted increased risk in cerebrovascular adverse events.

In response to the information identified in clinical trials, the Therapeutic Goods Administration (TGA) issued a Medication Safety Update for the use of Risperidone as a first line pharmacological treatment for behavioural disturbances in dementia. The drug manufacturer, Janssen-Cilag removed the implicit indication for use in patients with vascular or mixed dementia.

In response the updated clinical indications, two of our nursing homes work collaboratively to reducing the use of Risperidone in their facilities. This posed a challenge, as well an opportunity. Ceasing the prescribing and administration of pharmacotherapy could not be implemented without a change in clinical practice and culture within the homes.

The homes set about to implement a comprehensive training program for caregivers, focused on upskilling the workforce in non-pharmacological interventions for behavioural disturbances. The homes collaborated with local tertiary educational and healthcare providers to deliver the training modules. The leadership team within the homes further supported the training through a cultural changed focused on enhanced communication within the multidisciplinary team. These strategies, a focus on education and communication, positively reinforced each other to empower the care staff to implement improved clinical practice. 

We collaborated with the care-recipients and their families to implement a revitalised activities and therapy program. The activity programme in the home focussed on providing emotional support and wellbeing. Morning walking and individual activities increased. Occupational therapy assistants (OTAs) increased focus on meeting care recipients needs and preferences as they arose, while providing a stimulating program which included concerts and social events. The activity programme was extended to afternoon and weekend hours to cater for sun downing periods and provide additional individualised support.

The program was effective in reducing the use of Risperidone with the diagnostic group by 2.5% and any pharmacotherapy as an intervention by 8.0% over the twelve-month period. Over the same time, the number of admissions of this diagnostic group increased by 54%. The number of care-recipients prescribed no anti-psychotic increased from eight to 17. Over the corresponding period, there was no significant change in adverse incidents. The homes successfully reduced the risk of adverse side effects of Risperidone whist maintaining their therapeutic outcomes including quality of life, and physical and psychosocial functioning.

More information about this program

Jennifer Grieve at jgrieve@hallprior.com.au or call (08) 9321 1388

Changed
Friday, 21 December 2018 - 6:28am