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Tooele Care Center Uses Individualized Interventions to Reduce Anti-Psychotic Medication Use

By: Paige Fieldsted, Sr. Communications Specialist, HealthInsight Utah

The use of anti-psychotic medications is down at Rocky Mountain Care – Willow Springs after one simple idea snowballed into a successful campaign to help reduce medication use among residents with dementia. 
Sara Young, director of nursing at Willow Springs, said the care center started looking at their anti-psychotic usage last year after they were contacted by HealthInsight Utah staff about the Partnership to Improve Dementia Care in Nursing Homes, a Centers for Medicare & Medicaid Services initiative to ensure appropriate care and use of antipsychotic medications for nursing home patients. Young said she attended the 2014 Utah Healthcare Association annual conference in September of last year, where she got the idea to implement the Music & Memory program from a video shown at the conference.

“That is when we had our big turnaround moment,” Young said. “We got a computer with music and iPods from the state. We chose patients and filled their iPod shuffles with music. Whenever those patients started to have a behavior instead of giving them medicine, we would go get their shuffles and try that first. It was amazing how their behaviors decreased over time.”

Young said the staff saw such positive results from using music they decided to try implementing other interventions as well. She said some residents like to go for walks, have a snack or change their clothes to help them calm down whenever they start to get restless and anxious. She said other residents like to play with baby dolls or what the staff calls busy boxes.

Young said they have six different busy boxes; one is full of different balls in different shapes, sizes and textures; while others have picture books or crafts. They even have a big basket full of socks that one resident likes to fold when she gets restless.

“Each person is so individual on what intervention works for them but if you find the right one, it works,” Young said. “It gives them something to do and we don’t have to drug them to get them to calm down. We want them to be as natural and in their natural personality as they can.”

The care center has seen significant improvements in unnecessary drug use because of their efforts. Young said in the third quarter of 2014 the center had 14.3 percent of patients using anti-psychotic drugs but by the first quarter of 2015 that number had dropped to just 5.3 percent.

“When we first started our anti-psychotic push we saw the use of anxiety medication rise a little but as we continued to use the interventions we saw residents didn’t need the anxiety medications anymore either,” Young said.

According to Young, using the center’s electronic health record (EHR) to keep track of which interventions had been tried with each resident made it easier to find the intervention that worked best for each individual. Young also said having the entire staff on board was critical to their success.

“The staff loves it,” Young said. “If you don’t have everybody on board it won’t work. From the administration to the aides, everyone was so excited to try it and they could see how it was working. We don’t have to give so many medications anymore.”

Young said any care center can do the things the staff at Willow Springs has been doing it just takes passion, teamwork and having the right resources available to the right people.

Young considers having the busy boxes, iPods and other intervention tools readily available for the aides to use crucial to successful intervention because behaviors can occur anytime night or day. She also said teamwork and backing other staff members up when they have a resident who needs more attention are critical.

“If one resident is having a really bad day and needs to go for a walk, our staff is very team oriented and they back each other up and help out while one aide takes the time to take a resident for a walk,” Young said. “If there is something we can do before giving medication we are going to try it again and again. These people are entrusted in our care at a vulnerable time in their life, the last thing they need is to be drugged because we won’t take time out for them.”