Aiming to lower antipsychotic medicine given to dementia patients

Published 10:00 pm Sunday, June 18, 2017

NEW RICHLAND — A change in how society treats and views people with dementia, and other age-related cognitive disorders, has led to the development of a program that aims to lower the amount of antipsychotic medicines given to those with the disorders.

The Performance-Based Incentive Payment Program, through the Minnesota Department of Human Services, has provided a grant to New Richland Care Center. The grant requires facilities to submit reports every six months to document their progress, and the money given through the grant is based on the care center’s performance in lowering the amount of antipsychotic medicine given to patients.

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New Richland Care Center has used part of the funding to hire PIPP Director Sandy Hart, who began implementing strategies to achieve this goal.

“Changing the culture has been the most difficult, I think,” Hart said. “Because (the staff) have been so task-centered, and they get a little anxious if they’re not done with something at a certain time.”

Instead of following previously set schedules, staff are encouraged to be proactive at deterring challenging or combative behaviors the antipsychotic medicines are intended to target. Part of doing this, according to Hart, means understanding that behavior is a form of communication.

Hart tells the staff to stop what they’re doing, get down to the patient’s’ level and say, “OK, what’s wrong?” “How can I help you?” “What do you want me to do?”

Another aspect includes a changing of perspective.

“A lot of (the patients) now, they remember more of their past life than their present life,” Hart said. “They are in that stage, so meeting them where they’re at is very important. We can’t change that they can remember what they did today tomorrow. They just don’t remember that.”

“It used to be that you tried to bring them up to present day,” she said. “We’re not doing that anymore. This is their quality of life. We’re just letting them talk about themselves, what they did, and just go with them, walk down memory lane.”

Hart gave an example of a man who was determined to find the facility’s basement because he knew they had to have one. The center doesn’t have one, so there was no way for Hart to oblige his request to see it.

Instead of potentially upsetting the man, Hart played along. They walked the halls checking several doors before Hart said the stairs to the basement must be behind one of the locked doors she doesn’t have a key for. The man was satisfied with their effort and was then easily redirected to something else.

Other strategies are being implemented, including having a therapy dog at the facility, the use of aromatherapy, music therapy and the addition of an It’s Never Too Late system. The system is a computer-based program with several applications including games, old television shows and music.

Hart said it has been a valuable asset as she has seen an increase in participation among residents who use the program.

“Things have changed around here,” Hart said. “We are seeing more and more people wanting to do different things.”

The job of proactively keeping patients comfortable has now fallen on all the staff, instead of only the nurses, as well. Everyone from the kitchen staff and janitors are being taught how to recognize precursors to challenging behaviors and have been encouraged to be part of the solution by either warning nursing staff or providing a distraction by asking the resident to help them with their job or striking up a conversation with them.

It’s a change in thinking, but one that is aimed at individualized, patient-centered care.

“It’s all about them,” Hart said. “It’s not about us.”