FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes

Abstract

Objectives: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes.

Method: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs).

Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation.

Results: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes.

Discussion and conclusions: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.

Keywords:

• antipsychotic medication and dementia
• care homes
• training, staff roles
• quality of care
• person centred care

Acknowledgements

This work is based on original research conducted at King's College London, in association with Oxford University, University of Newcastle and Oxford Health Foundation NHS Trust. Copyright of the original FITS manual is held by Dr Jane Fossey (Oxford Health Foundation NHS Trust) and Dr Ian James (University of Newcastle). With many thanks to the staff at the Alzheimer's Society James Pickett, Anne Corbett, Clive Ballard, Nicola Hart and Keara O'Connor: the independent Steering Group chaired by Jane Fossey that advised on the design and provided helpful comments on early drafts and included Barbara Woodward-Carlton (AS), Robin Jacoby (University of Oxford), Claire Surr (University of Bradford) and Karen Culshaw (CQC). The Biomedical Research Centre for Mental Health and the Biomedical Research Unit for Dementia at King's College London both supported the input of Clive Ballard. Finally, this programme would not have worked at all without the dementia care coaches working in care homes. Our particular thanks go to all of the care homes and dementia care coaches who showed extraordinary commitment to their work on the FITS programme and to improving the lives of all the residents in their care.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This work was supported by a grant from the Alzheimer's Society [grant number 168] to the University of Worcester with support from the Department of Health and HC-One.