Home' Australian Pharmacist : Australian Pharmacist May 2013 Contents Australian Pharmacist May 2013 I ©Pharmaceutical Society of Australia Ltd. 39
So, what were the RedUSe project's key
findings? The sample size was large,
with just under 1,600 residents' medicines
lists audited for each measure. Over the
six-month project, there was a statistically
significant reduction in the percentage
of intervention aged care residents
taking antipsychotic medicines (20.3%
to 18.6%, p<0.05), whereas overall use
increased in the control group (20.9%
to 22.9%). The doses of antipsychotics
were tracked from baseline to week 26.
For residents taking antipsychotics at
baseline, there were also significantly
more dose reductions or cessations in the
intervention than in control ACFs (37%
versus 20.9%, p< 0.01).
The RedUSe project was a novel
intervention study that evaluated the
impact of pharmacist led audit-based
educational strategies on ACF
antipsychotic rates. The project strategies,
featuring clinical audit, staff education
and interdisciplinary review, successfully
reduced antipsychotic use and were well
received by all stakeholders. Further,
the project significantly increased the
number of dose reductions of these
agents. It should be noted that RedUSe
also proved successful in reducing
benzodiazepine prescribing rates.
Importantly, the project's findings
validate the potential role of Australian
community pharmacists in ensuring
the appropriate use of psychoactive
medicines in ACFs through drug
utilisation audit, education and
Risperidone for George?
Returning to our case study -- although
it may be tempting to recommend a trial
of a small dose of risperidone for George,
it is important to realise that any benefit
would be modest and its use is associated
with a range of potential adverse effects.
Non-pharmacological strategies such
as providing non-stressful activities,
reassurance, orientation therapy and
light exercise are recommended.
An assessment of his pain and possible
other behavioural triggers is worthwhile.
Does he have worsening arthritis or pain
that may need treatment? A Norwegian
study demonstrated that a systematic
approach to the treatment of pain
can reduce agitation in people with
moderate to severe dementia living
in aged care facilities; the effective
management of pain could reduce the
number of unnecessary prescriptions for
psychotropic drugs in this population.29
Does George have to have a shower every
morning? Are there any staff members who
he responds to better? George's family
could be consulted about what might
work to reduce his agitation (e.g. music,
warm bed baths).
Organisations such as the Dementia
Behavioural Management Advisory
Service (DBMAS) are available in each
State and offer a 24-hour phone support
line where carers and health practitioners
can receive expert advice on managing
BPSD. They also have excellent online
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3. Briesacher BA, Limcangco MR, Simoni-Wastila L, et al. The quality of
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dementia: time for action. An independent report commissioned
and funded by the Department of Health. London: UK Department
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behavioral symptoms and the use of psychotropic medication in
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Table 1. Some key principles of antipsychotic drug use for behavioural
symptoms in dementia.1,8,9
Before therapy is introduced the target behaviour should be identified. Use
antipsychotic medicines only if aggression or psychotic symptoms cause severe distress
or immediate risk of harm.
Behavioural problems such as wandering, inappropriate verbalisation or touching, and
sleeplessness are unlikely to respond to antipsychotic therapy.
Adverse effects of concern include cerebrovascular events, falls, confusion, accelerated
cognitive decline, pneumonia and extrapyramidal symptoms.
Among all antipsychotics, risperidone has the most evidence for efficacy in managing
BPSD and is the only atypical antipsychotic that is PBS listed for this indication.
Review the need for antipsychotic therapy for behavioural symptoms of dementia
within three months of starting and regularly thereafter.
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