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Alternatives to Chemical Restraints in the Long Term Care Setting, Part II

This is the second of a two-part series related to  challenging perceptions about alternatives to chemical restraints in the long term care setting for residents with Alzheimer’s or other causes of dementia.  

Below are recommendations that afford the opportunity to use alternatives to chemical restraints with this unique population.  

1.   Approach is everything...make the resident your focus, determine what he/she likes as a reward.
2.   Build rapport; help resident to recognize you as a person who is friendly and supportive.
3.   Modify the environment- eliminate distractions to increase focus, know the residents personal, cultural history.
4.   Work closely with staff; know what works, and what doesn't.
5.   Use multi-sensory cues.
6.   Use positive statements and praise for efforts leading to completion of task.
7.   Do not use terms of endearment; honey, sweetie, sugar, or dear.
8.   Problem solve with caregivers to find effective strategies.
9.   Use non-threatening body language.
10.   Use calm, audible voice, use one step requests, avoid giving too much information, don't ask yes or no questions...the answer most of the time will be "no".
11.   Realize your thoughts are real, and automatic negative thoughts - ANT's - don't always tell the truth.
12.   Train your thoughts to be positive and hopeful.
13.   Replace the negative with the positive.
14.   Psychotropic medications are among the most frequently prescribed agents for elderly nursing home residents.
15.  Older people, and people suffering from a dementing illness are susceptible to overmedication and negative reactions from a combination of drugs.
16.   To get the needed results, doctors can't always eliminate the side effects.  You and your doctor must work closely to achieve a balance. 
17.   Ask what side effects to watch out for, and communicate what you see.
18.   The focus should be to eliminate the underlying cause of the behavior rather than medicate the behavior.
19.   In cases where medication cannot be eliminated, the focus should be to; maximize the resident’s potential and wellbeing, and minimize the hazards associated with medication side effects.
20.   Increase understanding of non-medication treatment, and approach strategies.
21.   Change the approach, redefine the problem, if the behavior doesn't cause harm, don't medicate the behavior.
22.   Ask yourself,  "What's my goal,"  this is to improve resident’s quality of life.  
23.   Ask resident "What is troubling you, and how can I help"... if you find you are getting impatient or angry, leave.
24.   Remind caregivers they can make a difference.
25.   Decide how to respond, rather than react, to the behavior., don't take behavior personally.
26.  Be confident, yet flexible in your approach, avoid frustration and negativity.
27.  Think safety first.
28.   Staff training regarding antipsychotic medications is key to any efforts to reduce drug use in long term care.
29.   Resident quality care improves with staff empowerment.
30.   We can't change the person, so we have to change our approach.

"Antipsychotic medications pose a great risk for elderly residents, especially those with dementia.  They can increase the risk of death in these residents and may put elders with dementia at greater risk for a stroke.  They also have many negative side effects such as weight gain, agitation, sleepiness, gastrointestinal problems, dry mouth, worsening cognitive problems, and fatigue to name a few.

These drugs must help stabilize or improve the person's clinical outcomes, quality of life, and functional capacity.  The FDA regulations indicate that these drugs cannot be used simply for behaviors of wandering, poor self-care, restlessness, impaired memory, mild anxiety, insomnia, unsociability, fidgeting, nervousness, uncooperative behavior, verbal outbursts, and behaviors that don't endanger the resident or others.

They should be used to treat an enduring condition only when target behaviors are clearly and specifically identified and monitor, and usage must be documented over time.  The behavioral issues must be re-evaluated periodically to determine if medication dose reduction or discontinuation are viable options."

From July 2012 issue of Provider; The Troubling Role of Antipsychotics.  Solving The Mystery, Providers are finding alternatives to antipsychotics by doing some old fashioned detective work. by Joanne Kaldy 


Tags: nursing home operations, nursing home occupancy, staffing