Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide.

Why This Tool?

This tool, The Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia Discussion Guide, is designed to help providers understand, assess, and manage residents in LTC homes with behavioural and psychological symptoms of dementia (responsive behaviours), with a focus on antipsychotic medications. It was developed as part of Centre for Effective Practice’s Academic Detailing Service for LTC homes. it is specifically designed to engage providers in meaningful discussions with our Academic Detailing Team. It may however, be useful to providers, administrators, residents, caregivers and families. It is free to download. Please review the copyright statement on the back of the guide if you intend to adapt or reference the Discussion Guide.

This Discussion Guide integrates:
  • best-practice evidence,
  • clinical experience, and
  • makes reference to relevant existing tools and services wherever possible.
Important principles include:
  • being mindful of benefits,
  • risks and safety concerns,
  • using an interprofessional team approach and validated tools,
  • prescribing conservatively, and
  • reassessing regularly for opportunities to deprescribe medications that are no longer needed.

As always, efforts must be made to individualize any treatment decisions for the resident, with consideration for caregivers, family as well as LTC staff.

TOOL

 

THE DISCUSSION GUIDE IN 10 SUMMARY POINTS

  1. Describe and identify the BPSD symptom cluster(s)
  2. Document behaviour accordingly
  3. Identify cause(s) of BPSD
    • Consider using a tool such as P.I.E.C.E.S.
    • Address or treat underlying cause(s)
  4. Engage caregivers and family to the extent possible
  5. Manage symptom(s) with individualized non-drug therapy
  6. If drug therapy is chosen and/or non-drug therapy fails:
    • Weigh potential benefits vs. risks of chosen drug therapy
    • Obtain and document informed consent
    • Consider antipsychotics in residents with:
      • Psychosis
      • The resident poses an imminent risk of harm to other residents or staff
      • Severe and disruptive agitation or aggression
  7. Monitor and document non-drug and drug therapy for effectiveness and adverse effects
  8. Follow-up accordingly. If antipsychotics are used, reassess need every 3 months
  9. Consider deprescribing of drug therapy when appropriate
  10. Continue to individualize non-drug approaches.

Any such summary statements may suffer from seeming to under-appreciate the complexity of very challenging situations. Thus, the art of day-to-day application needs to accompany good intentions. We trust that the “detail” in this document and in our academic detailing discussions will be part of exploring answers to such challenging problems. Thank you for your efforts, big or small, in working to address these challenges!

 

VIEW OUR
DISCUSSION GUIDE

MEET THE
TEAM

SUPPORTING MATERIAL
& REFERENCES

BASIC
TRAINING

WHAT HAPPENS
IN A VISIT?

NOMINATE
A TOPIC

Disclaimer

This Tool was developed by Centre for Effective Practice (CEP) with input and review from our Academic Detailing Service Team, including our clinical leads Drs. Andrea Moser and Sid Feldman. In addition, target end-users and other relevant stakeholders provided input during the development process. This Tool was funded by the Province of Ontario as part of CEP’s Academic Detailing Service. For more information on the Academic Detailing Service, our Team and/or the development process please visit: effectivepractice.org/academicdetailing.

This Tool was developed for licensed health care professionals in Ontario as a guide only and does not constitute medical or other professional advice. Primary care providers and other health care professionals are required to exercise their own clinical judgment in using this Tool. Neither the Centre for Effective Practice (“CEP”), Ontario College of Family Physicians, Nurse Practitioners’ Association of Ontario, Government of Ontario, nor any of their respective agents, appointees, directors, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through this Tool; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of this Tool by an individual including, but not limited to, primary care providers or entity, including for any loss, damage or injury (including death) arising for or in connection with the use of this Tool, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any external sources referenced in this Tool (whether specifically named or not) that are owned or operated by third parties, including any information or advice contained therein.

ccUse of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide: Long-Term Care (LTC) Edition is a product of the Centre for Effective Practice. Permission to use, copy and distribute this material for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and the following paragraphs, and appropriate citations appear in all copies, modifications,

and distributions. Use of the Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide: Long-Term Care (LTC) Edition for commercial purposes or any modifications of the tool are subject to charge and use must be negotiated with the Centre for Effective Practice ([email protected]).

For statistical and bibliographic purposes, please notify the Centre for Effective Practice ([email protected]) of any use or reprinting of the tool. Please use the below citation when referencing the tool:

Reprinted with Permission from Centre for Effective Practice. (April 2016). Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide: Long-Term Care (LTC 2nd Edition).

cc