Reducing antipsychotic medications? Try these behavioral interventions (LTL mag online)

Posted by Dr. El - November 26, 2012 - Medication issues - No Comments

Here’s my latest article on Long-Term Living magazine online:

Reducing antipsychotic medications? Try these behavioral interventions

With the recent focus on reducing antipsychotics in long-term care and substituting behavioral interventions, facilities may be left wondering what interventions to use and how to implement them. Here are ideas on how to prevent, investigate and monitor agitation on your units and address staffing needs to ease the transition from antipsychotic medication.

PREVENTION: BORROW FROM THE PSYCHIATRIC HOSPITAL

In a psychiatric hospital, the focus is on creating an emotionally healing environment—a therapeutic milieu. In long-term care, the focus is on providing high-quality physical healthcare and the frequently neglected therapeutic milieu can contribute to resident agitation. Take some time to walk your units and evaluate the emotional environment. This is what residents, and especially those with dementia, are reacting to and small changes can make a big difference.

Evaluate and adjust the physical environment. Is it disturbingly bright or so dark that older eyes can’t see who’s approaching? Is it very loud, with excessive overhead paging, chair alarms and shouting staff and residents? Is it too cold or too warm? Make environmental changes so that an older version of you wouldn’t mind spending time in the day room.

Provide appropriate programming. Are residents crammed together in a small area for long periods of time, creating the sensation of being trapped? Is the main activity a blaring television set? A therapeutic milieu is all about engaging the residents in appropriate activities with a pleasant flow through the day. Pursuits for residents with dementia can include music, baking, tactile and visual stimulation, etc. Providing activities off the unit offers additional stimulation to those who can tolerate it and lessens crowding in the day room. It can also offer a healthy diversion for cognitively intact residents.

Calm residents before they get agitated. The time for staff to act is when interactions between residents start to become tense, rather than waiting until an argument has broken out. Interventions such as distraction, redirection and a face-saving move to another location can be remarkably effective. Attending to individuals at early signs of distress can prevent episodes of full-blown agitation.

Use customer service techniques. Well-trained staff can often prevent agitation from occurring. Units can be transformed by charge nurses who speak to residents and staff alike in calm, respectful tones, address needs immediately and expect the aides working with them to do the same.

Staffing recommendations:  

  • Train all your staff in customer service techniques.
  • Offer special workshops for nurses, aides and recreation therapists on providing care and activities for residents with dementia.
  • Consider hiring nurses with psychiatric experience who understand how to maintain a therapeutic milieu.

INVESTIGATE: PUT ON YOUR SHERLOCK HOLMES HAT

If a resident is agitated despite environmental changes, look for underlying causes.  Residents with dementia are often unable to speak through words, so they use other methods. Sometimes it takes a bit of sleuthing to figure out what they’re saying.

For more, visit LTL magazine online:

Reducing antipsychotic medications? Try these behavioral interventions

For more details on behavioral interventions, download Dr. El’s FREE report: Stop Agitating the Residents!