CLeAR supported long-term care homes in BC to provide person-centred care for residents with the behavioural and psychological symptoms of dementia (BPSD).

Clear was a clinical quality improvement initiative guided by Choosing Wisely’s recommendation on using antipsychotic medications to treat BPSD in cases where nonpharmacologic measures have failed, and where the symptoms either cause significant suffering, distress and/or pose an imminent threat to the patient or others.

Wave 3 supported care homes across the province whose use of antipsychotics (without a diagnosis of psychosis) is higher than the BC average of 25%. This included both affiliated and health authority owned-and-operated care homes and represents the most care homes to ever participate in Clear.

Featured CLeAR Resources

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CLEAR Wave 3 Technical Report

The aim of Clear Wave 3 was to reduce the rate of antipsychotic use in residents without a diagnosis of psychosis from baseline to the national average by April 30, 2019. 33 participating care homes across BC completed the collaborative. This technical report outlines in detail the evaluation results of Wave 3 which spanned from…
Download CLEAR Wave 3 Technical Report
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CLEAR Wave 3 Summary Report

The aim of Clear Wave 3 was to reduce the rate of antipsychotic use in residents without a diagnosis of psychosis from baseline to the national average by April 30, 2019. 33 participating care homes across BC completed the collaborative. This summary report contains an overview of the evaluation results from Wave 3 which spanned…
Download CLEAR Wave 3 Summary Report
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CLeAR Wave 2 – Final Evaluation Report

Clear’s second wave ran from September 2015 through December 2016, during which it was known as the Call for Less Antipsychotics in Residential Care. To help participating care homes measure Clear’s impact, they divided residents into two groups: an “Original Cohort” of residents who were admitted prior to the start of Clear, and an “Additional Cohort”…
Download CLeAR Wave 2 – Final Evaluation Report
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CLeAR Wave 1 – Final Report

This report shares the story of the first wave of CLeAR (the Call for Less Antipsychotics in Residential Care), which featured 48 participating care homes and ran from October 2013 to December 2014. Action & Improvement teams made significant progress towards their goals by adapting existing knowledge to their own environments, with many individual homes seeing dramatic…
Download CLeAR Wave 1 – Final Report

Clear Faculty were clinical experts from throughout the province who have knowledge and expertise in many aspects of this initiative. They provided expert advice, coaching and mentorship to participating teams. This was done in several ways: local workshops, provincial webinars, email and team or individual calls.

Anita Wahl, Clinical Nurse Specialist, Fraser Health
Ann Marie Leijen, Consultant, Rebalance Rehab
Ashok Krishnamoorthy, Geriatric Psychiatrist, Vancouver Coastal Health
Carol Ward, Geriatric Psychiatrist, Interior Health
Dacia Reid, Manager Program Practice and Education, Island Health
Jasjit Gill, PIECES Representative and Educator, Vancouver Coastal Health
Johanna Trimble, Patient Partner, Patient Voices Network
Judy Macdonald, Clinical Pharmacist
Katharine McKeen, Family Physician (Victoria)
Marcia Bertschi, Quality Advisor, Northern Health
Zainab Diesta, Director of Care, George Derby Centre

The Partnership Alliance represents key stakeholders in the field of dementia care, who provided overall guidance to Clear and identify opportunities for alignment between partners and Clear.

Alzheimer’s Society of BC
BC Care Providers Association
BC College of Family Physicians
BC Psychogeriatric Association
College of Pharmacists of BC
Denominational Health Association
Division of Geriatric Psychiatry at UBC
Ministry of Health
Office of the Seniors Advocate
Public Guardians and Trustee of BC
SafeCare BC
Worksafe BC

CLeAR

Clear is supporting long-term care homes to carry out effective behavioural care planning and management that will lead to a reduction in the number of their residents who are prescribed antipsychotic medications

Interested in getting an idea of what has been happening in BC addressing antipsychotics in long-term care? Have a look at this BCCPA report: A Pathway to Ensuring the Appropriate Use of Antipsychotics in Continuing Care.

The CLeAR Approach

The following milestones provide a practical “roadmap” for the improvement journey. These milestones build upon themselves as the work progresses with some more focused on “Getting Started” and others on “Rolling Out the Work.”

The goal of the milestones is to develop an effective approach to behavioural care planning and management that will support the needs of the residents, while fostering the appropriate use of antipsychotic medication. High-impact changes and resources for each milestone have been identified below that provide further direction for this work.

Teams

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When Psychosis Isn’t the Diagnosis: A Toolkit for Reducing Inappropriate Use of Antipsychotics in Long Term Care

This toolkit supports interventions to reduce the excessive use of antipsychotic medications in long term care homes. The content is derived from the Appropriate Use of Antipsychotics Toolkit developed by Alberta Health Services and adopted by Choosing Wisely Canada. It can be used by physicians, clinical services or care homes to help achieve reductions in…
Download When Psychosis Isn’t the Diagnosis: A Toolkit for Reducing Inappropriate Use of Antipsychotics in Long Term Care
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BPSD Algorithm Mobile Tool

The BC BPSD Algorithm is a practical, electronic and interactive tool that supports interdisciplinary, evidence-based, person-centred care for persons with behavioural and psychological symptoms of dementia (BPSD). It is very simple to use and completely mobile-friendly – meaning that you can use it on your smartphone, tablet or laptop. The algorithm is intended to be combined…
Access the Tool BPSD Algorithm Mobile Tool


Getting Started

Measurement Resources

Webinar Recording: Measurement & Data Collection Tool

Watch a one-hour recorded webinar covering measurement and demonstrating the Data Collection Tool. You are required to enter a password to view the recording – the same one you would have used to access the live webinars. Please contact us at clearbc@healthqualitybc.ca to request a password.

Quality Improvement Resources

Driver Diagram – Clear Wave 3

This document provides suggested strategies and changes to reduce antipsychotic medications in long-term care. Here’s a video that explains how driver diagrams are used in improvement work.

Culture Change Toolbox

The Culture Change Toolbox is a collection of tools and interventions for changing culture. It’s full of ideas, examples, and exercises. For each tool there are tips on how to apply it and a description of which components of culture it helps to improve. The Toolbox was released in 2014, so we thought it was time for…

“Leadership in QI is about creating a shared vision, aligning improvement activities with the vision, building will by engaging others to generate ideas and execute change, and nurturing a culture in which to grow and sustain improvement efforts.” (Institute for Healthcare Improvement)

High-Impact Changes

  • Receive and review the improvement data
  • Test, then establish flexible tactics and persevere until a solution is found – staff should be supported and given the autonomy to be the primary drivers behind this work
  • Leaders spend time with direct care staff, residents and families/caregivers to hear about issues and concerns on the unit/village/home
  • Celebrating successes and thanking staff for their hard work

Key Resources

VIDEO — Clear Webinar: Fostering Trust and Leadership
On July 12, our guest speakers Karen Bowen and Kathryn Proudfoot talked about the different ways you can foster trust and leadership among teams. We also heard from Zainab from the New Vista Care Home who shared her story of how her team used a personalized approach to care with positive results!

9 Essential Skills of a Healthcare Quality Improvement Leader
This article explores nine critical leadership behaviors exhibited by individuals and organizations committed to health care quality improvement.

IHI 5 Whys: Finding the Root Cause
One way to identify the root cause of a problem is to ask “Why?” five times. When a problem presents itself, ask “Why did this happen?” Then, don’t stop at the answer to this first question. Ask “Why?” again and again until you reach the root cause.

Other Resources

Leadership in Quality Improvement: Building the Will and Organizational Culture to Support Improvement

IHI Framework For Improving Joy In Work
This white paper is intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, “What matters to you?” — enabling them to better understand the barriers to joy in work and co-create meaningful, high-leverage strategies to address these issues.

While providing effective education and training can be challenging because of time and cost, it is fundamental to being able to understand and support the specific needs of residents. There is a broad range of education and training approaches and programs available that could be targeted to a variety of staff as well as to family. An in-house train-the-trainer/mentor “just in time” approach is generally the most effective for staff.

High-Impact Changes

  • Obtain leadership support
  • Identify, prioritize and participate in key education resources for current and new staff
  • Establish a train-the-trainer/peer coaching approach

Key Resources

P.I.E.C.E.S. Training 

G.P.A. Training 

SafeCare BC Training 

Provincial Violence Prevention E-Learning Modules

Teepa Snow

DementiAbility 

Other Resources

Appropriate Use of Antipsychotics in Dementia — What Is All The Fuss?
A good overview for understanding the appropriate use of antipsychotics, providing evidence for use, adverse effects and which behaviours may respond.

Use of Antipsychotics in Behavioual and Psychologic Symptoms of Dementia (BPSD) Discussion Guide
This tool is designed to help providers understand, assess and manage residents in long-term care homes with behavioural and psychological symptoms of dementia (responsive behaviours), with a focus on antipsychotic medications. It is laid out in a very practical style and illustrates how to integrate P.I.E.C.E.S. into practice.

VIDEO — Dr. Ian Bekker: Antipsychotics – When Should They Be Used With People With Dementia?
Training for staff at Glengarry Hospital (and others) on the role of antipsychotics in the care of the residents.

A Dementia Roadmap for Practitioners
A roadmap for outlining the stages of dementia – symptoms, sign-posts, good questions and tasks for the practitioner.

Dementia: Understanding and Managing Challenging Behaviour
If you are someone looking after a family member with dementia in your own home or a professional working with people with dementia, this free online course will help you better understand the person and develop the skills needed to manage their responsive behavior.

Guidelines for the Recognition, Diagnosis and Management of Cognitive Impairment
This guideline provides recommendations for adults 19 years or older within the primary care setting but will support understanding of dementia in the long-term care setting as well. It focuses on Alzheimer’s disease, the most common form of dementia in primary care.

Putting the P.I.E.C.E.S. Together in the Health Care Maze 
A story illustrating the benefits of the P.I.E.C.E.S. (Physical, Intellectual, Emotional, Capabilities, Environment, Social) framework, a tool created in Canada for those who work with older adults who have complex health issues.

Dignity and quality of life are central to the lived experience in long-term care. Person- or resident-centred care is the overarching philosophy to guide the approach to care and care delivery and is not a task to do. Care is organized around the person receiving care, and care providers, clients and their families are equal partners in the care delivery process, ensuring that the person’s needs and preferences are met.

High-Impact Changes

  • Establish and communicate a vision of resident-centred care for your care home working with staff and resident/family
  • Identify and institute a bedside “getting to know me”-type tool
  • Identify education opportunities for family/caregivers about dementia and BPSD and provide accurate information and education about the potential benefits and harms of antipsychotics

Key Resources

PC P.E.A.R.L.S. — 7 Key Elements of Person-Centred Care 

Getting to Know Me (Revised)

Getting To Know Me — Daily Care Needs

Communication — Four Steps to Better Communication with Residents 

Involving Families in Appropriate Use of Antipsychotics — Mel’s Story

Other Resources

How Antipsychotic Medications are Used to Help People with Dementia — A Guide for Residents, Families and Caregivers
As a member of the care team, you have an important role to play in helping the health care providers decide whether this treatment is a good choice for your family member or friend. This guide will help you learn more about how antipsychotic medications are used to help people with dementia.

Caregiving After Facility Placement 

All About Me Booklet
All About Me is a resource for people with dementia to tell health care providers about themselves – their needs, likes, dislikes and interests – so that the providers can build relationships with them and support personalized care.

All About Me: A Conversation Starter
All About Me: A Conversation Starter is a shorter version of the All About Me Booklet that gives staff and visitors  a “snapshot” of the person in order to start a conversation.

A Guide to Creating a Life Story for Care-giving
Life Stories are a small snapshot of the person’s life put into mini-photo albums or picture frames and the information contained is used by health care providers to give more person-centred care. This guide is written from the perspective of using the Life Story as a tool to better support the care for persons with dementia.

My Life Story Book
This PowerPoint contains the template for completed a Life Story Book.

How to Use Personal Information in Care-giving: Tips for Health Care Providers

When Your Loved One Has Dementia – A Roadmap for Families
While different kinds of dementia vary in their initial presentation and rate of progression, there are features of the dementia journey common to all. This brochure is a basic roadmap of the territory to help families orient themselves on the journey their loved one is travelling, and see what’s coming further along the road.

Pieces of My Personhood Tool

Dementia Care Matters – Person-Centred Appraisal Documents

  • How To Be Person-Centred (BPC) – Explanation of the Appraisal Approach
  • Appraisal Form: Being Person-Centred
  • Emotions and Risk Assessment Approach

What Matters to You? A Guide to Having Conversations About What Matters
This resource provides tools specific to providers (in the first section) and then for patients, family members or caregivers (in the second section), to help spark “What matters to you?” conversations.

High-Impact Changes

  • Create an environment of respectful communication, teamwork and learning
  • Implement focused Safety Rounds and team huddles on the unit to proactively identify and care plan for resident behavioural concerns
  • Identify local champions to support staff during challenging care situations
  • Debrief with staff following incidents resulting in harm associated with BPSD

Key Resources

VIDEO — Clear Webinar: Exploring Foundations of Strong Teamwork & Communication
On June 14, 2018, guest speaker Kathryn Proudfoot (BCPSQC) helped us explore the role non-technical skills play in our work, and how culture impacts health care improvement. Teams came away with practical exercises to help apply some of these new skills. Improvement advisor Geoff Schierbeck showed how the Clear measurement tool can be used to track PDSAs.

VIDEO — Clear Webinar: Engaging in Effective Communication
On June 28, 2018, our guest speaker Karen Bowen, an Organizational Development Consultant, talked about the different ways you can effectively communicate that benefit both culture and teamwork. This webinar will help your Clear team recognize elements of unstructured and structured communication, explore different communication styles and the dangers of triangulation.

VIDEO — Clear Webinar: Navigating Conflict Successfully
On August 2, our guest speakers Karen Bowen and Kathryn Proudfoot talked about navigating conflict successfully among teams. Check out the engaging webinar below, with practical tips and tools. We heard from two of our Clear teams who told us about tools they were using successfully. Anju from Elim Village told us how her team is using huddles. Erin from Simon Fraser Lodge also spoke to us about her team’s success with physician engagement.

Other Resources

Decide on a Starting Point; Gather an AUA Change Team 

Get the Word Out at Your Site 

Build Awareness within the Facility or Unit

Create Desire in the Care Team 

Overcome Resistance to Change on Your Unit 

Develop Knowledge Within the Care Team in the Five Key Areas 

Rolling Out the Work

Measurement Resources

Webinar Recording: Capturing PDSAs in Your Spreadsheet

Watch this 3 minute video diving into how the Clear measurement tool can be used to track PDSAs. You are required to enter a password to view the recording – the same one you would have used to access the live webinars. Please contact us at clearbc@healthqualitybc.ca to request a password.

Quality Improvement Resources

Driver Diagram – Clear Wave 3

This document provides suggested strategies and changes to reduce antipsychotic medications in long-term care. Here’s a video that explains how driver diagrams are used in improvement work.

Culture Change Toolbox

The Culture Change Toolbox is a collection of tools and interventions for changing culture. It’s full of ideas, examples, and exercises. For each tool there are tips on how to apply it and a description of which components of culture it helps to improve. The Toolbox was released in 2014, so we thought it was time for…

High-Impact Changes

  • Introduce the BPSD Algorithm as the basis for the approach to assessment and management, breaking this tool down into manageable segments for reference and use of the tools
  • Through the train-the-trainer approach, implement an assessment approach
  • Implement behaviour tracking

Key Resources

A Dementia Roadmap for Practitioners
A roadmap for outlining the stages of dementia – symptoms, sign-posts, good questions and tasks for the practitioner.

BPSD Algorithm
The BC BPSD Algorithm is a practical, electronic and interactive tool that supports interdisciplinary, person-centred care for persons with behavioural and psychological symptoms of dementia (BPSD). The algorithm provides evidence-based tips and tools and non-pharmacological approaches to person-centred dementia care, many of which can be accessed in the other milestones.

Introducing the BC BPSD Algorithm
This presentation dives into the history of the BPSD Algorithm and provides a brief orientation of the tool.

P.I.E.C.E.S. Assessment Tool 

P.I.E.C.E.S. ABC Tool

Dementia Observational System (DOS)

SBAR for BPSD

NOPPAIN Tool

Pain Assessment in Advanced Dementia (PAINAD) Scale

Putting It All Together – RAI-P.I.E.C.E.S. Integration Job Aid

Cohen-Mansfield Agitation Inventory

Integration of the P.I.E.C.E.S. holistic person and care partner-centered approach into shared assessment and care planning

VIDEO — P.I.E.C.E.S. Part One: Tapping into Creative Caregiving: Inspiration, Innovation and P.I.E.C.E.S.
In Part One, Dr. Carol Ward, Geriatric Psychiatrist, describes a successful integration of the P.I.E.C.E.S. holistic person and care partner-centred approach into the shared assessment and care planning within a specialized intensive inpatient program to support those living with complex neuropsychiatric symptoms and behavioural changes.

VIDEO — P.I.E.C.E.S. Part Two: Story of Ann

Other Resources

Pain Matters — A Family Guide to Pain Management in Dementia Booklet

The Rosehaven Provincial Program –The Bethany Group: P.I.E.C.E.S. Assessment Tools

Responsive Behaviours Quick Reference Cards 
This resource from the Dementia Training Australia group provides 11 cards divided into each of the basic categories of responsive behaviors (i.e. anxiety, vocally disruptive, etc.). The file enables users to create their own pocket sized reference material.

High-Impact Changes

  • Identify, test and implement non-pharmacologic approaches that are tailored to the resident’s interests and appropriate for the person’s skills and abilities, particularly recreation and activity

Key Resources

VIDEO — Clear Webinar: Non-Pharmaceutical Interventions for Managing BPSD
On May 9, 2018, our Clinical Faculty member Dacia Reid gave a webinar where teams were able to understand more about non-pharmaceutical interventions for managing BPSD. A former Clear team from Northern Health also spoke about some of the simple activities they do with their residents to address behaviours.

VIDEO — Clear Webinar: Recreation Therapy
On May 23, 2018, our guest speaker Jan Robson (Alzheimer Society of BC) talked about a person-centred approach and recreation therapy for individuals with BPSD. Erin Buskermolen, from one of our Northern Health Clear teams at Simon Fraser Lodge in Prince George, demonstrated the power of the Dementia Observational System (DOS).

VIDEO — Clear Webinar: Recreation Therapy: Tools of the Trade
On September 13, our guest speaker Laura McGill of the Alzheimer Society of Toronto talked about the importance of recreational therapy and the tools we can use to implement these strategies right away.

Non-Pharmacological Interventions Document from the BPSD Algorithm

Music & Memory 

VIDEO — Alive Inside

Other Resources

A Doctor’s View — Depression in Long-Term Care Residents

Nursing Home Toolkit: Promoting Positive Behavioral Health
This toolkit contains resources to help staff in senior living communities promote non-pharmacologic behavioural strategies to address behavioural and psychologic symptoms of distress (BPSD) that frequently occur in long-term care settings, especially among residents with dementia. It is divided into a number of sections, with a specific section on the evidence and strategies for non-pharmacologic approaches, including two tables to help address the challenges:

Recreation Therapy to Promote Mobility Among Older Adults in Long-Term Care
An overview of scientific evidence and current practice.

Impact of Antipsychotic Review and Non-Pharmacological Intervention on Antipsychotic Use…The WHELD study

Non-pharmacological Approaches to Managing Behavioural and Psychiatric Symptoms of Dementia
This paper reviews behavioural approaches to managing BPSD.

Receptive Music Therapy Is More Effective than Interactive Music Therapy to Relieve Behavioural and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis

High-Impact Changes

  • Augment current care planning sessions (e.g., new admission as well as yearly care conferences) and implement new BPSD/antipsychotic care planning sessions (e.g., weekly or monthly) – include direct care staff, specifically care aides
  • Include resident and family/caregivers as part of the team, communicating through formal letters, engaging one-on-one through annual care conferences (“enhanced”)
  • Implement “just in time” brief care planning on the units to support staff when dealing with difficult and potentially unsafe care situations, including huddles
  • Track, communicate and follow up to determine the effectiveness of the care plan, including all levels of staff as well as the resident/family/caregivers
  • Enable a change in staff responsibilities to address resident needs 24/7, e.g., sit with residents and talk, play cards, etc.
  • Match staff composition to resident needs 24/7, e.g., more staff at the end of the afternoon for “sun-downing”

Key Resources

View the tools from the resident-centred care milestone, the assessment milestone and the therapeutic activities milestone for tools that support care planning (some of the tools are again listed below).

BC BPSD Algorithm
The BC BPSD Algorithm is a practical, electronic and interactive tool that supports interdisciplinary, person-centred care for persons with behavioural and psychological symptoms of dementia (BPSD). The algorithm provides evidence-based tips and tools and non-pharmacological approaches to person-centred dementia care, many of which can be accessed in the other milestones.

Interior Health Behavioural Care Planning Template
Interior Health, Long Term Care Services, has developed a resident-centered approach to care planning and the resources include a care plan template, a brief instruction guide and care plan examples.

GPA Training

DementiAbility

Behavioural Escalation Continuum Model

AUA — Family Conference Tracking Record

Collaboration Huddle Guide

Other Resources

Huddle Role Play Activity

My Daily Care Needs — Filled In

Starter Toolkit for Engaging Staff in Individualizing Care — The Pioneer Network
This toolkit is designed to activate quality improvement through individualized care by helping homes put in place the four foundational systems: consistent assignment, huddles, involving CNAs in care planning, and Quality Improvement (QI) closest to the resident.

See previous milestones, particularly for physician and pharmacist involvement in team, assessment and care planning, as well as in the next milestone on reduction/elimination of antipsychotics.

High-Impact Changes

  • Informing, through to involving, physicians in the decisions around BPSD management, antipsychotic medication adjustments, appropriate prescribing, while assuring them that the care staff would receive education about dementia and alternatives for behaviour management plus families would be notified/involved
  • Involve pharmacists to look at all meds with psychotropic effects, either directly or as adverse effects (e.g., anticholinergics)

Key Resources

VIDEO — Clear Webinar: Physician Engagement
Feedback from the Kick-Off Workshops included requests for support in engaging physicians in Clear. On March 21, 2018, our Clinical Leads Ian Bekker and Chris Rauscher provided an overview of physician engagement strategies and shared some draft communication templates we’re working on.

VIDEO — Clear Webinar: Appropriate Use of Antipsychotics in Dementia – What’s All the Fuss?
On April 18, 2018, our Clinical Faculty members Ashok Krishnamoorthy and Judy MacDonald gave a webinar where teams were able to understand more about the use of antipsychotics in the treatment of specific mental health disorders, learn to recognize different classes and effects of antipsychotics used in long-term care, and receive some ideas for sharing this information with families.

A Dementia Roadmap for Practitioners
A roadmap for outlining the stages of dementia – symptoms, sign-posts, good questions and tasks for the practitioner.

Behaviors That ARE Likely to Respond to Medications

Behaviors NOT Likely to Respond to Medications

P.I.E.C.E.S. Assessment Tool

Dementia Observational System (DOS)

SBAR for BPSD 

Antipsychotic (AP) Deprescribing Algorithm

Clear Antipsychotic Tapering Request Form
The Dose Reduction Template has been developed to facilitate communication with your physician about reducing antipsychotic use for a specific individual with BPSD.

Other Resources

Guidelines for the Recognition, Diagnosis and Management of Cognitive Impairment​
This guideline provides recommendations for adults 19 years or older within the primary care setting. It focuses on Alzheimer’s disease, the most common form of dementia seen in primary care. The guideline encourages early recognition and assessment of dementia and supports the development of a care plan that includes the identification of community resources for patients and caregivers.

Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide – Long-Term Care Edition
This tool is designed to help providers understand, assess and manage residents in long-term care homes with behavioural and psychological symptoms of dementia (responsive behaviours), with a focus on antipsychotic medications. It was developed as part of Centre for Effective Practice’s Academic Detailing Service for long-term care homes. This tool integrates best-practice evidence with clinical experience, and makes reference to relevant existing tools and services wherever possible.

Practice Recommendations for Initiation, Titration and Tapering of Antipsychotic Medications
This decision support tool helps guide clinicians to initiate, titrate, reduce and monitor antipsychotic medications and is a resource meant to accompany the BC BPSD Algorithm.

Antipsychotics in the Treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) in the Elderly – Evidence Summary
This brief evidence summary has been developed by the Shared Care Polypharmacy Risk Reduction initiative to support medication decision-making

Deprescribing Antipsychotics for Behavioural and Psychological Symptoms of Dementia and Insomnia

Working through the previous milestones will make the efforts at reducing and eliminating antipsychotics much more effective.

High-Impact Changes

  • Identify which residents may no longer require their antipsychotic medication, while applying the assessment and care planning approaches as well as the non-pharmacologic support approaches
  • Establish a measurement system to generate the data for identification of residents on an antipsychotic and follow the changes from reduction to elimination
  • Enhance medication review processes, specifically reviewing antipsychotic medications more frequently

Key Resources

Choosing Wisely Antipsychotics Getting Started Toolkit
This resource lists practical steps leading to effective antipsychotic medication reviews and tapering, including suggesting which residents to target.

Suggested Steps for Developing an Antipsychotic Medication Review Process

Enhancing the Medication Review Process

Behaviors That ARE Likely to Respond to Medications

Behaviors NOT Likely to Respond to Medications

Clear Antipsychotic Tapering Request Form
The Dose Reduction Template has been developed to facilitate communication with your physician about reducing antipsychotic use for a specific individual with BPSD.

Antipsychotic (AP) Deprescribing Algorithm

Other Resources

Pharmacologic Restraint Management Worksheet

Medstopper

Physicians

BPSD Algorithm
The BC BPSD Algorithm is a practical, electronic and interactive tool that supports interdisciplinary, evidence-based, person-centred care for persons with behavioural and psychological symptoms of dementia (BPSD).

Practice Recommendations for Initiation, Titration and Tapering of Antipsychotic Medications
This decision support tool helps guide clinicians to initiate, titrate, reduce and monitor antipsychotic medications and is a resource meant to accompany the BC BPSD Algorithm.

When Psychosis Isn’t the Diagnosis: A Toolkit for Reducing Inappropriate Use of Antipsychotics in Long Term Care
This toolkit supports interventions to reduce the excessive use of antipsychotic medications in long-term care homes.

A Dementia Roadmap for Practitioners
A roadmap for outlining the stages of dementia – symptoms, sign-posts, good questions and tasks for the practitioner.

Guidelines for the Recognition, Diagnosis and Management of Cognitive Impairment
This guideline provides recommendations for adults 19 years or older within the primary care setting. It focuses on Alzheimer’s disease, the most common form of dementia seen in primary care. The guideline encourages early recognition and assessment of dementia and supports the development of a care plan that includes the identification of community resources for patients and caregivers.

Putting the PIECES Together in the Health Care Maze
A story illustrating the benefits of the PIECES (Physical, Intellectual, Emotional, Capabilities, Environment, Social) framework, a tool created in Canada for those who work with older adults who have complex health issues.

You Decide Sheet for Antipyschotics in Treatment of BPSD in Elderly
Shared Care’s Polypharmacy Risk Reduction Initiative created this evidence-based summary which has been reviewed by an expert clinical advisory group to inform medication reviews and decision making

Best Practices Guide for Safely Reducing Anti-Psychotic Drug Use in Residential Care
The BC Care Providers Association (BCCPA) has developed this guide to help long-term care providers reduce the use of anti-psychotic drugs in their long-term care homes.

“It’s Your Medicine, What Shall We Do With It?”
The Health Foundation published a short video about a medication review project in the UK that “brings together care home residents, their families and health professionals to ensure residents are getting the right mix of medications.” Among the project’s achievements is reducing the amount of medicine prescribed to residents by 17%.

Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide
This tool is designed to help providers understand, assess and manage residents in long-term care homes with behavioural and psychological symptoms of dementia (responsive behaviours), with a focus on antipsychotic medications. It was developed as part of the Centre for Effective Practice’s Academic Detailing Service for long-term care homes. This tool integrates best-practice evidence with clinical experience, and makes reference to relevant existing tools and services wherever possible.

Agitation in Dementia: Quantifying the Effects of Antipsychotics
This document answers the question: What are the benefits and harms of antipsychotics for agitation in dementia?

Evidence Summary: Antipsychotics in the Treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) in the Elderly
Most people with dementia will experience BPSD at least once during the course of their disease. The focus of this document is on the behavioural component.

Families & Caregivers

When Your Loved One Has Dementia – A Roadmap for Families
While different kinds of dementia vary in their initial presentation and rate of progression, there are features of the dementia journey common to all. This brochure is a basic roadmap of the territory to help families orient themselves on the journey their loved one is travelling, and see what’s coming further along the road.

All About Me: A Booklet About a Person Living with Alzheimer’s Disease or Other Dementia
All About Me is a resource for people with dementia to tell health care providers about themselves – their needs, likes, dislikes and interests – so that the providers can build relationships with them and support personalized care.

Shifting Focus – A Guide to Understanding Dementia Behaviour
This booklet is meant to help family members, friends and co-residents of those who live at home or in a long-term care home and are behaving in unpredictable ways that create unease or distress. It helps care partners and fellow residents to learn about the brain and how dementia affects it; recognize your family member’s actions and their meaning; offer ways to respond; and increase patience and acceptance for those living with dementia.

Dementia – Understanding and Managing Challenging Behaviour
If you are someone looking after a family member with dementia in your own home or a professional working with people with dementia, this free online course will help you better understand the person and develop the skills needed to manage their challenging behaviour.

Living with Dementia
This brutally honest film reminds us that although dementia causes the loss of some abilities, people’s feelings remain intact. Four people with dementia talk about their emotions: fear, guilt, embarrassment, isolation, powerlessness. The film also shows the difference a supportive, empathetic relationship can make.

“Dementia-Friendly Communities” and Being Dementia-Friendly in Health Care Settings
This review discusses the concept of “dementia-friendly communities” and summarizes the latest research and practice around such communities. This review also highlights important topic areas to be considered to promote dementia-friendliness in health care settings.

Home Recreates Past for Dementia Patients
Watch a video about a Georgian Bay, Ontario retirement home that has carefully recreated the past for dementia patients who find the environment comforting.

How Antipsychotic Medications are Used to Help People with Dementia
As a member of the care team, you have an important role to play in helping the health care providers decide whether this treatment is a good choice for your family member or friend. This guide will help you learn more about how antipsychotic medications are used to help people with dementia.

Clear Webinars

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CLeAR Webinar – Pain Management

Do you ever wonder about how to manage your residents’ pain? Are you looking for practical tips and strategies for pain management? On this webinar, Dr. Romayne Gallagher from Providence Health Care and Susannah Stewart from Kiwanis Pavilion joined forces to share useful information about pain management approaches as well as several helpful hints for…
Watch Now CLeAR Webinar – Pain Management
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All Teach All Learn: Huddles

Hear from Anju from Elim Village, a Clear Wave 3 Supporter, talk about how her team uses huddles. See their huddle script and toolkit below. You are required to enter a password to view the recording – the same one you would have used to access the live webinars. Please contact us at clearbc@healthqualitybc.ca to…
Watch Now All Teach All Learn: Huddles
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Clear Monthly Webinar: Engaging in Effective Communication

On June 28, 2018, our guest speaker Karen Bowen, an Organizational Development Consultant, talked about the different ways you can effectively communicate that benefits both culture and teamwork.  This webinar will help your Clear team recognize elements of unstructured and structured communication, explore different communication styles and the dangers of triangulation. Also, you will hear how…
Watch Now Clear Monthly Webinar: Engaging in Effective Communication
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Clear Monthly Webinar: Exploring Foundations of Strong Teamwork and Communication

Clear Webinar Series – On June 14, 2018, guest speaker Kathryn Proudfoot (BCPSQC) helped us explore the role non-technical skills play in our work, and how culture impacts healthcare improvement. Teams came away with practical exercises to help apply some of these new skills. Improvement Advisor Geoff Schierbeck showed how the Clear measurement tool can…
Watch Now Clear Monthly Webinar: Exploring Foundations of Strong Teamwork and Communication
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Clear Monthly Webinar: Appropriate Use of Antipsychotics in Dementia – What’s All The Fuss?

On April 18, 2018, our Clinical Faculty members, Ashok Krishnamoorthy and Judy MacDonald gave a webinar where teams were able to understand more about the use of antipsychotics in the treatment of specific mental health disorders, learn to recognize different classes and effects of antipsychotics used in long-term care, and receive some ideas for sharing…
Watch Now Clear Monthly Webinar: Appropriate Use of Antipsychotics in Dementia – What’s All The Fuss?