Improving antipsychotic agent use in nursing homes: development of an algorithm for treating problem behaviors in dementia.

Many issues related to safety and quality care emerge from reports that nearly one in three nursing home residents is treated with antipsychotic medication, a rate that exceeds levels that led to nursing home reform more than 2 decades ago. Atypical antipsychotic medications have become the mainstay of treatment for behavioral problems among residents with dementia, despite federal "black box" warnings about health risks and research demonstrating their limited effectiveness. The purpose of this article is to briefly describe a dissemination research project designed to increase appropriate antipsychotic prescribing for older adults with dementia. A step-wise problem-solving algorithm designed to reduce unnecessary psychotropic medication use is described. Formative evaluation results provided by nursing home personnel are reviewed. Discussion focuses on nursing home culture as an important influence on the adoption of evidence-based practices and changes needed to promote use of behavioral interventions in dementia care and reduction of reliance on antipsychotic medications.

Depression training for nurses: Evaluation of an innovative program.

This article describes evaluation results related to a CD-based depression training program that incorporates the collaborative care principles of the Improving Mood-Providing Access to Collaborative Treatment (IMPACT) model of care. The four-part training program used workplace exercises and case-based learning to change daily care practices as part of the training. The relevance and application of depression assessment, treatment, care planning, communication, and referral methods were addressed using a mixed-methods evaluation that accompanied the dissemination of 513 training packets statewide. Evaluations were returned by 250 participants. Items related to the extent to which training changed care practices (n = 19) and outcomes of care for older adults (n = 13) consistently received high scores. Responses to open-ended questions resulted in positive comments related to assessment, monitoring, communication, and interventions such as scheduling pleasant activities. Results indicate the training program may positively influence nursing practice and collaboration with interdisciplinary providers.