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Pharmacists trained to reduce sedative use in aged care

Published 18 Feb 2020

The fight to reduce the high level of sedative use in aged care continues with the training of interstate pharmacists to implement the highly successful RedUSe (Reduce the Use of Sedatives) program in rural and remote areas.

The program, led by Dr Juanita Breen from the University of Tasmania’s Wicking Dementia Research and Education Centre, is a multi-strategic, interdisciplinary, structured initiative targeting the inappropriate use of sedatives in Registered Aged Care Facilities (RACF’s) around Australia.

After an initial and successful trial in Tasmania in 2008, Dr Breen introduced the RedUSe intervention nationally to more than 12,000 aged-care residents in 150 RACFs, with promising results.

“During the project, each RACF’s sedative medication use was measured, nursing and care staff attended training sessions on psychotropic medication and residents taking these medicines were reviewed by nursing staff, pharmacists and their GP,” Dr Breen said,

“Following the introduction of RedUSe, statistics showed a significant reduction in the use of psychotropic medication in RACFs with approximately 40 per cent of residents ceasing  their antipsychotic or benzodiazepine medication completely, or having their dosage reduced.”

Dr Breen recently assisted The Aged Care Quality and Safety Commission to select and train 11 pharmacists around the country to implement the RedUSe program.

In Tasmania, several pharmacists were trained as part of the original RedUSe trial and Victorian pharmacists from the latest training round will also be used to service King Island and Tasmania’s West Coast.

RedUSe’s approach includes pharmacist-run training in RACF’s around the correct use of medications and alternative approaches, and bringing nurses, pharmacists and doctors together to reduce the prescribing of antipsychotics and benzodiazepines.

Dr Breen’s research initially showed around two-thirds of RACF residents were prescribed psychotropic medications to manage high rates of sleep disturbance, anxiety, depression and the behavioural and psychological symptoms of dementia.

“For at least two decades concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged-care facilities, due to the modest therapeutic benefits and high risks,” Dr Breen said.

“These medications aren’t effective in many cases and can lead to many side effects including a higher risk of falls, pneumonia and stroke.”

The overuse of sedatives in aged care facilities was also recently highlighted in the Royal Commission into Aged Care, at which Dr Breen gave evidence.

Dr Breen said she had received an overwhelmingly positive response to the RedUSe project from staff at RACFs around the country, having been approached by more than 300 facilities to be a part of the current project.

She now hopes the momentum of the program will continue to see it in place in more RACFs around in the country.

“I hope the feedback and results speak for themselves and the key concepts of the project –which are  audits for awareness, quality training that challenges beliefs that all medications are beneficial, and a review process with a nurse, pharmacist and prescriber – are embedded into routine practice,” she said.

“In Australia we have programs delivered through pharmacies that would allow sustained delivery of this program, yet, at present, these are unmonitored and not used to their full effect.”

“It would be great to see RedUSe and similar initiatives funded and available for all RACFs through these pharmacy programs.”

Find out more about the RedUSe here: https://www.utas.edu.au/health/research/groups/wicking-centre/RedUSe

The Wicking Dementia Research and Education Centre is part of the University's College of Health and Medicine.