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Training Program & Use of Antipsychotics in NHs

JAMA Intern Med; ePub 2017 Apr 17; Tjia, et al

Publish date:: May 2, 2017

Prevalence of antipsychotic use in a nursing home setting declined during the implementation of a communication training program; however, the decrease did not continue in the maintenance phase, a recent study found. The study included 93 nursing homes (NHs) enrolled in the OASIS intervention compared with 831 nonintervention NHs and sought to qualify the influence of a large-scale communication training program on NH antipsychotic use. Researchers found:

Among OASIS facilities, prevalence of atypical antipsychotic prescribing were 34.1% at base and 26.5% at the study end compared with a drop of 22.7% to 18.8% in the comparison facilities.
In the OASIS implementation phase, however, NHs experienced a reduction in antipsychotic use prevalence among OASIS facilities greater than that among non-OASIS facilities.
No increases in other psychotropic medication use or behavioral disturbances were observed.

Citation:

Tjia J, Hunnicutt JN, Herndon L, Blanks CR, Lapane KL, Wehry S. Association of a communication training program with use of antipsychotics in nursing homes. [Published online ahead of print April 17, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.0746.

Commentary:

Antipsychotic medications are often used off-label for control of behavioral symptoms in patients with agitated dementia. However, there is limited evidence of their efficacy and they can increase cardiovascular mortality over a relatively short period of time, which has led the FDA to issue a boxed warning about this particular use.^1,2 This study looked at a novel educational intervention for improving nursing staff communication with patients and showed a meaningful decrease in antipsychotic use during the active educational period. Agitation in elderly patients with dementia is a challenging issue, and while antipsychotics seem to work sometimes, we should consider systematic educational interventions to minimize their use. —Neil Skolnik, MD

Gill SS, Bronskill SE, Normand SL ,et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007;146(11):775- 786.
US Food and Drug Administration. US Department of Health and Human Services. Public health advisory: Deaths with antipsychotics in elderly patients with behavioral disturbances. Published April 11, 2005. http://www.fda.gov/Drugs/DrugSafety /PostmarketDrugSafetyInformationforPatientsand Providers/ucm053171.htm. Accessed April 28, 2017.

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