Response to PIERRE’S REVIEW ON COMPETENCIES AND PRINCIPLES – POST 8.1
Hello Kamal,
Thank you for your post. Although we work in different health authorities and different settings, best practices seem to be universal. Employees need that personal touch to feel heard and respected.
I would like to provide a brief description of CLeAR for everyone else reading:
CLeAR stands for Call for Less Antipsychotics in Residential Care. The British Columbia Patient Safety & Quality Council (2017) describes CLeAR as
a quality improvement initiative that supports teams from residential care homes in British Columbia to address the behavioural and psychological symptoms of dementia (BPSD) with a focus on reducing inappropriate use of antipsychotics.
Antipsychotics are not the optimal choice for treating BPSD. These drugs are minimally effective, but increase the risk of stroke, unsteady gait, increased disruptive behavior, and death (Banerjee, 2009). The Canadian Academy of Geriatric Psychiatry and the Canadian Psychiatric Association recommend using these drugs only when measures not involving drugs have failed, and only if the behavior would be dangerous to self or others (Choosing Wisely Canada, 2017).
The Canadian Institute for Health Information (2017) says 25.9% of antipsychotics in British Columbia long-term care homes may be used inappropriately. With the minimal benefits and increased risks, many parties, including medical professionals and families, want to reduce the use of antipsychotics.
However, other medical professionals, nurses, families, and care staff resist change. As you said, “why change something that doesn’t need to be changed.” (Badesha, 2018) I agree with you about the need for communication, especially change talk. Perhaps one way of reframing the change is the use of expectancy theory.
Purvis, Zagenczyk, & McCray (2014) explain expectancy theory as “motivation on the degree to which an effort is perceived to lead to performance, performance leads to rewards, and the rewards offered are desirable.” In laymen’s terms, we answer the question, “what’s in it for me?” Why should care staff, nurses, families, and doctors care about this initiative? I have found discussing this question to be helpful with some stakeholders. For care staff and nurses, a decrease in antipsychotics may lead to lfewerside effects and deaths. We need to acknowledge when antipsychotics use is appropriate; CLeAR is fewer antipsychotics, not no antipsychotics.
For families, we can sell the idea of better health for their loved ones. Few families want to see residents with uncontrollable behavior, but these same families also don’t want their relatives to live as soulless zombies. We can convey the hope of managing the behavior while maximizing qthe uality of life.
Finally, for doctors, we can talk to them about potential side effects. Doctors know about the maxim of “start low and go slow” with medications. They are also aware of family sensitivity regarding overmedication. We can sell them on the idea of working together to maintain the highest quality of life.
Let me know what you think!
References:
Badesha, K. (2018). Response to Pierre’s review on competencies and principles – Post 8.1. Retrieved November 25, 2018, from https://create.twu.ca/kamalbadesha/2018/11/24/response-to-pierres-review-on-competencies-and-principles-post-8-1/
Banerjee, S. (2009, October). The use of antipsychotic medication for people with dementia: Time for action Retrieved November 25, 2018, from https://webarchive.nationalarchives.gov.uk/20130104175837/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108302.pdf
British Columbia Patient Safety & Quality Council. (2017). CLeAR wave 2: Final evaluation report. Retrieved November 25, 2018, from https://bcpsqc.ca/wp-content/uploads/2018/07/2017-CLeAR-Wave-2-Evaluation-Report-Aug-3-2017_FINAL.pdf
Choosing Wisely Canada. (2017). Psychiatry. Retrieved November 25, 2018, from https://choosingwiselycanada.org/psychiatry
Purvis, R. L., Zagenczyk, T. J., & McCray, G. E. (2015). What’s in it for me? Using expectancy theory and climate to explain stakeholder participation, its direction and intensity. International Journal of Project Management, 33(1), 3–14. https://doi.org/10.1016/j.ijproman.2014.03.003
