Evaluation of the antipsychotic medication review process at four long-term facilities in Alberta

Abstract

Purpose

The goal of this evaluation was to understand how four long-term care (LTC) facilities in Alberta have implemented medication reviews for the Appropriate Use of Antipsychotics (AUA) initiative. We aimed to determine how interprofessional (IP) collaboration was incorporated in the antipsychotic medication reviews and how the reviews had been sustained.

Methods

Four LTC facilities in Alberta participated in this evaluation. We conducted semistructured interviews with 18 facility staff and observed one antipsychotic medication review at each facility. We analyzed data according to the following key components that we identified as relevant to the antipsychotic medication reviews: the structure of the reviews, IP interactions between the staff members, and strategies for sustaining the reviews.

Results

The duration of antipsychotic medication reviews ranged from 1 to 1.5 hours. The number of professions in attendance ranged from 3 to 9; a pharmacist led the review at two sites, while a registered nurse led the review at one site and a nurse practitioner at the remaining site. The number of residents discussed during the review ranged from 6 to 20. The process at some facilities was highly IP, demonstrating each of the six IP competencies. Other facilities conducted the review in a less IP manner due to challenges of physician involvement and staff workload, particularly of health care aides. Facilities that had an nurse practitioner on site were more efficient with the process of implementing recommendations resulting from the medication reviews.

Conclusion

The LTC facilities were successful in implementing the medication review process and the process seemed to be sustainable. A few challenges were observed in the implementation process at two facilities. IP practice moved forward the goals of the AUA initiative to reduce the inappropriate use of antipsychotics.

Keywords:

• interprofessional
• antipsychotic
• senior
• medication review
• evaluation

Supplementary material

Figure S1 Interprofessional Antipsychotic Medication Review Checklist

Abbreviations: LPN, licensed practical nurse; HCA, health care aide; AUA, Appropriate Use of Antipsychotics; RN, registered nurse; PT, physical therapist; OT, occupational therapist.

Acknowledgments

We would like to thank the staff and managers from the long-term care facilities for generously contributing their time to this project.

Disclosure

The authors report no conflicts of interest in this work.