Antipsychotic drug use in Canadian long-term care facilities: prevalence, and patterns following resident relocation

Background and alms: Data on antipsychotic use were collected in two Canadian long-term care (LTC) facilities. During the one-year study, residents in one facility were relocated to a new facility, allowing examination of the changes in antipsychotic use associated with relocation. Method: A comparative descriptive design was used. Pharmacy and chart data on antipsychotic use were gathered for three separate one-month periods during one year. Data were collected both in a facility experiencing relocation of all residents to a new facility, and in a facility not undergoing relocation. The three one-month data collection periods covered a one-month period before the relocation, immediately after the relocation, and six months after the relocation. Results: In the facility not experiencing relocation, an average of 31.3 % of all residents were receiving antipsychotics. Residents in this facility received antipsychotics for an average length of 0.81 years, and 20.8 % of all antipsychotic prescriptions reflected dose reductions within six months of the start of the prescription. Only 8.1 % of prescriptions had accompanying documentation on the behavioral indication for the use of antipsychotics. A total of 73.4 % of all antipsychotics were 'atypical' antipsychotics, and 13.5 % of all antipsychotic prescriptions were written as 'p.r.n.',(as needed). While the use of antipsychotics remained relatively constant in the non-relocation facility (between 30.3 % and 33.1 % of all residents), the percentage of residents receiving antipsychotics in the facility experiencing a relocation climbed significantly; from 21.5 % six months before the move, to 32.6 % immediately after the move, to 36.9 % six months after the move. Conclusion: These findings, when compared with the U.S. standards on antipsychotic use (OBRA), suggest the need for additional research on antipsychotic use in Canadian LTC facilities.