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An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project

Published online by Cambridge University Press:  09 October 2009

Juanita Westbury ,
Shane Jackson ,
Peter Gee  and
Gregory Peterson
Juanita Westbury*
Affiliation:
Unit for Medication Outcomes, Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
Shane Jackson
Affiliation:
Unit for Medication Outcomes, Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
Peter Gee
Affiliation:
Unit for Medication Outcomes, Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
Gregory Peterson
Affiliation:
Unit for Medication Outcomes, Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
*
Correspondence should be addressed to: Juanita Westbury MSc, BPharm, University of Tasmania, Unit of Medication Outcomes Research and Education, School of Pharmacy, Private Bag 83, Hobart, Tasmania 7001. Phone: +61 3 6226 1966; Fax: +61 3 6226 7627. Email: [email protected].
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Abstract

Background: This study evaluated a multi-faceted, interdisciplinary intervention to reduce the use of benzodiazepines and antipsychotics in nursing homes – the “RedUSe” (Reducing Use of Sedatives) project.

Methods: The RedUSe project was a controlled trial conducted in 25 nursing homes in Tasmania, with 13 intervention and 12 control homes. A series of pharmacist-led strategies were provided to intervention homes including two medication audit and feedback cycles, educational sessions for staff and an interdisciplinary sedative review. Data on psychotropic drug use at each nursing home were collected utilizing a customized computer program at baseline, 12 and 26 weeks. The RedUSe project was registered as a controlled trial at the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12608000221358.

Results: For each measure, an average of 1591 residents were audited. Over the six-month trial, there was a significant reduction in the percentage of intervention home residents regularly taking benzodiazepines (31.8% to 26.9%, p < 0.005) and antipsychotics (20.3% to 18.6%, p < 0.05), whereas control home psychotropic use did not alter significantly. For residents taking benzodiazepines and antipsychotics at baseline, there were significantly more dose reductions/cessations in intervention homes than in control homes (benzodiazepines: 39.6% vs. 17.6%, p < 0.0001; antipsychotics: 36.9% vs. 20.9%, p < 0.01).

Conclusions: RedUSe led to a significant reduction in the proportion of residents in nursing homes taking benzodiazepines and antipsychotics, and a significant increase in the number of dose reductions of these agents. Our findings suggest that a multi-faceted program, coordinated through a community pharmacy, can offer an effective approach in reducing psychotropic use in nursing homes.

Keywords

antipsychoticbenzodiazepinenursing homesintervention trialpsychotropic
Type
2009 IPA JUNIOR RESEARCH AWARDS – THIRD-PRIZE WINNER
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 26 - 36
Copyright
Copyright © International Psychogeriatric Association 2009

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