Inappropriate use of antipsychotics | HQCA Focus

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Long Term Care

Inappropriate use of antipsychotics

Percentage of residents on antipsychotics without a diagnosis of psychosis. (see data definition)

Data source: Alberta Health Services, Analytics. “All 35 QIs by province/zone/facility”. (2024). [Dashboards showing RAI quality indicators, by province, zone, and site, by quarter]. AHS Tableau Reporting Platform.

What do you think?

  • Looking at these results over time, are there any trends?
  • Looking at these results over time and between zones, are there differences?
  • After selecting a facility, are the site results changing over time? How do the most recent quarter results compare to the provincial and zone results?
  • When comparing sites with similarities like zone, setting (e.g., urban or rural), operator type (e.g., private), and size, how are the results different? What factors could account for these differences?

Understanding "inappropriate use of antipsychotics"

Antipsychotic medications, such as or risperidone (Risperdal) or clozapine (Clozaril), can reduce or relieve symptoms of psychosis, such as delusions (false beliefs) and hallucinations (seeing or hearing something that is not there).

In long term care, some sites use them to calm residents with a high degree of agitation or aggression associated with living with dementia. This is considered a chemical restraint.

These medications have many harmful effects and therefore are not recommended or are to be used with caution. All other non-medication interventions should be tried and ruled out as a solution for the resident’s negative response to their situation, before antipsychotic medications are considered.

Alberta has undertaken a large-scale initiative to reduce the number of residents receiving antipsychotics inappropriately and increase non-pharmacological measures (e.g., therapy, peer support) to help residents become more comfortable in their environments.

Considerations when viewing the results:

When thinking about this quality indicator, providers and leaders can consider a number of things to better understand and improve these results. Some questions they could ask before taking action include:

  • What behaviours are being controlled through the use of antipsychotics?
  • What other interventions could be used instead of antipsychotics?
  • Are residents experiencing side effects from these medications, which warrant a review of their use?

Alberta Quality Matrix for Health

The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess long term care’s performance in these dimensions of quality: Acceptability, Appropriateness, Effectiveness, and Safety.