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Appropriateness of Antipsychotic and Sedative Prescribing to Older Adults

Audit and feedback as an effective method for self-reflection on practice data and coaching for practice change in supportive, peer-to-peer environments
2018

Appropriateness of Antipsychotic and Sedative Prescribing to Older Adults

Project Partners

  • Seniors Health Strategic Clinical Network (Alberta Health Services)
  • Clinical Analytics (Alberta Health Services)
  • Central Zone (Alberta Health Services)

Objective

This project was a partnership with Alberta Health Services Seniors Health Strategic Clinical Network (SCN) and quality improvement leaders in the Central Zone. Our objective was to identify clinically relevant and actionable improvement opportunities based on administrative data. By providing individual physicians with data on their prescribing practices and using the Calgary Audit and Feedback Framework (CAFF), we looked to foster self-reflection on prescribing practice, identify improvement opportunities and facilitate practice change.

Project Summary

In March 2019, PLP and partners engaged Central Zone family physicians in an audit and feedback intervention focused on the appropriate prescribing of antipsychotic and sedating medication to older adults living in supportive living facilities and the community. 

Administrative data demonstrates significant variation in prescribing habits for these medications across the five health zones in Alberta.

 

 

Sedating medications queried for this project include antipsychotics, antidepressants, benzodiazepines and other nervous system medications used primarily for sedating purposes in older adults.

All family physicians prescribing to older adults in Wetaskiwin, Alberta were invited to participate, and those who consented were included in a peer comparator group. Participating physicians were provided with individualized reports and aggregate peer comparator data regarding current prescribing practices for sedating medications to older adults aged 65 and older between January 1, 2017 and December 31, 2018. Individual data reports were confidential and were meant to foster self-reflection, discussion and practice change.

Upon review of their data, participants engaged in a peer-facilitated audit and feedback session, led by a local physician champion, to identify the barriers and facilitators to changing practice. Participants left with a list of improvement ideas prioritized by impact and ease of implementation. 

 

Conclusion

The audit and feedback session offered participants a unique opportunity for self-reflection on their practice data and coaching for practice change in a supportive, peer-to-peer environment. Moving forward, data will be analyzed to monitor prescribing pattern changes. PLP is also working to develop a strategy for spreading access to prescribing reports for physicians across Alberta.

 

Audit & Feedback

2017

Appropriate Use of Antipsychotic (AUA) Medications in Calgary Zone Supportive Living Sites

Project Partners

  • Seniors Health Strategic Clinical Network (Alberta Health Services)
  • Clinical Analytics (Alberta Health Services)

Objective

This project was a joint effort between PLP and the Seniors Health SCN to spur the Appropriate Use of Antipsychotics (AUA) in Supportive Living. Two project objectives were identified: 

  • Include physicians in the engagement process to ensure all critical team members work together to co-develop strategies for improving patient care
  • Provide an opportunity for teams from multiple sites to exchange AUA best practice ideas with one another

Project Summary

We engaged interdisciplinary care teams in a half-day process improvement workshop. During the workshop, comparative antipsychotic prescribing data was shared as a baseline for improvement efforts and to stimulate friendly competition. Interdisciplinary health care teams – including physicians, medical residents, case managers, registered nurses, pharmacists, nurse practitioners and other support staff – participated in a series of process improvement activities:

  • Developed vision statements to guide their work
  • Identified and prioritized improvement opportunities
  • Developed an action plan for change – including specific deliverables, owners and timelines for implementation
  • Shared their top improvement ideas with other teams

Following the workshop, summary reports were provided to each participating Supportive Living site. The report provided a site-specific prioritization matrix and action plan for improving AUA utilization. Summary reports also contained a compiled list of improvement ideas from all participating sites.

Sample Report Content

Conclusion

Multidisciplinary workshops for site-based teams are effective in engaging physicians in process improvement.

We offered participating teams the freedom to locally plan and implement improvements that generated high quality and actionable improvement plans. By engaging 33 care providers from six Supportive Living sites, we were able to generate six action plans with over 60 improvement ideas.