International Psychogeriatrics

2009 IPA JUNIOR RESEARCH AWARDS – THIRD-PRIZE WINNER

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

Juanita Westburya1 c1, Shane Jacksona1, Peter Geea1 and Gregory Petersona1

a1 Unit for Medication Outcomes, Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia

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.

(Received August 11 2009)

(Accepted August 24 2009)

(Online publication October 09 2009)

Correspondence:

c1 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: Juanita.Westbury@utas.edu.au.