Care before convenience – sector experts create accessible education modules around psychotropic drug use

To say the aged care industry and its staff have ignored the conversation around psychotropic drug use is to ignore the heartfelt and dedicated pursuit of thousands. Aged care managers, clinical staff and front-line personnel continue to try to understand and manage this immensely complicated care. Psychotropics, any medication that is able to impact the mind, emotions and behaviour of a human, have seen considerable government oversight, but it is in how to manage care for seniors with dementia, particularly in the daily-routine, that confusion around psychotropics has grown. Staff have felt confused, uncomfortable, and stretched in the often intense atmosphere of care while trying to develop better practices.

Dr Amanda Cross is a leading pharmaceutical-researcher who has, alongside team-members, been tackling the realities of aged care demands, and how to educate and support on the ground, not in theoretical fantasy. Her research and insight showcases a sector and academia collaborating for lives, both seniors and staff, changed. Recognising the challenge of trying to educate when time is pressed led the team to innovating knowledge video-modules to meet aged-care working dynamics.

To uplift staff to feel empowered with timely and accessible information is progress happening, by the sector, for the sector. Supporting on-site aged care pharmacists to be able to keep up to date with the latest research and compliance on psychotropics, and to be able to, in reality, provide that information to front-line staff, is how reform is landed. Rallying to create innovative teaching methods around psychotropic use, that can educate across disciplines, cultures and languages, may not be straightforward or convenient, but it is a move of substance to support elevated care.

Complicated

Cross shares that to begin this discussion, it is important to name the intricacies and sensitivities at play. Seniors, sector, staff are all managing a topic that is weighty, “psychotropics, and the management of symptoms for which psychotropics are often used, are complex.”

Far from having arrived at a definitive position of their use in care, she highlights that it is worthwhile for the conversation to include exploring opportunities, findings and alternatives. Aged care managers, family-members and staff, all must be welcome at the table, “I think one of the main conversations I have is about the limited evidence for effectiveness of psychotropic medicines in managing changed behaviours in people with dementia.”

“Psychotropic medicines often only have minimal benefit, if any, and they carry a high risk of harms such as falls, sedation, delirium and stroke.”

Cross names a pain-point in care, “sometimes we use them out of desperation for something”. And still, many experts, advocates and front-line staff are wondering about alternatives, “but the conversation needs to be what else could we do, what non-pharmacological strategies could we try that are tailored to the individual and the unmet needs they may be experiencing.” For this approach, advocates and front-line staff attest, resources and education must be lifted to support those on the ground with alternatives.

“If we do need to use psychotropic medications, it needs to be at the lowest effective dose for the shortest time, and we need to be proactively monitoring benefits and harms”, Cross notes.

In order to navigate this level of insight, education needed to be provided to those actually providing care; Enter the projects she and her team members have been working on.

Policy to practice evolution

Cross sees the new requirements as an opportunity to reflect on and improve the sector’s practice, and to bolster those managing and facilitating care in providing that care not through rote but through a deep understanding. She notes that increased reporting of antipsychotic use is set to provide valuable information.

She speaks of the heart and mind for learning. She has noticed, from conversations with pharmacists and front-line staff in aged care, a profound thirst for knowledge to do better with the complex use of psychotropics: “the data shouldn’t just be collected to tick a box, it should prompt a conversation.”

Staff have been vocal on forums across social media and to unions, they want the space to have conversations within their facilities, with clinical professionals, to improve, to understand, to be empowered to tackle the complicated better, “[data] it should be presented at the medication advisory committee meetings and incorporated in broader quality improvement processes, helping us to better understand our current practice and identify areas where we can improve.”

She honours the blistering pace that many in aged care tackle day in and day out. While aged care stories of dedication, commitment, and perseverance through exhaustion see less attention than others, Cross consistently works alongside professionals with incredible stamina who simply want the support to do their best. 

“Health and [aged] care staff are busy with their critical day-to-day caring responsibilities, and we need models of knowledge translation that can work within that environment.”

Supporting professionals for best impact

Cross and her colleagues noticed a knowledge gap, “there have been a lot of changes in recent years, and there are constantly new evidence and guidelines being released” but how to get this information to people working at breakneck speeds, managing and providing care? She and her team respected that work had to be done to provide bridges to educate and upskill, without further burdening aged care professionals.

“Our EMBRACE study and MEGA-MAC study both evaluated the role of upskilling key healthcare professionals in aged care to act as knowledge brokers to help take a big, long, complex guideline and integrate it into the local context of a residential care home. This was very well accepted by care home staff, and I think it will be a really important role moving forward.”

She describes how the study tackled the reality of aged-care pharmacists, their time-pressured schedules, and how to innovatively help them impact and support more aged care workers, to compound the positive benefits. The trial and eventual solutions had to be couched in the realities of care, which meant rose-tinted glasses were off, and innovation hats were on.

“In our trial setting, we only had our knowledge broker pharmacists focused on implementing the Guidelines. In practice, aged care onsite pharmacists have many roles across resident care, medicine safety, education and clinical governance. Current funding is for only 0.2FTE per 50 beds, so pharmacists need to work smarter (and harder)!”

Cross explains tackling the operational obstacles, “in the EMBRACE study, our pharmacists found that the traditional one hour more didactic education just wasn’t suited to the busy, 24/7, care environment. It was difficult to reach staff who worked on different days or nights, and impractical to expect people to be ‘off-the-floor’ attending an education for that duration.”

For Cross and the team, thoughts from aged care providers were necessary to respect and recognise difficulties and to steer solutions. “This was the same feedback we got from our four participating aged care providers.”

It was from listening to care challenges on the ground that the team came up with the solution: “the micro-learning videos were developed to address this feedback.” 

“They [micro-videos] can be used by aged care onsite pharmacists in short 10-minute learning sessions at handover or in those rare ‘quiet moments’, and they focus on key fundamentals to support the safe and appropriate use of psychotropics for people with dementia. They can also be viewed standalone by health and care staff, supporting capacity building of all staff.”

Research supporting sector

In close partnership with aged care providers, Cross and the team worked in close proximity. Findings weren’t top-down; they were ground-borne.

From the EMBRACE trial, Cross notes, “early insights have really shown the positive impact of targeted knowledge translation of guidelines into practice.” 

From spending time directly with providers and staff, “we’ve learnt a lot about the types of resources and strategies that can help, and also a lot of insights which can support the roll-out of the new aged care onsite pharmacist model.”

Micro-videos supporting the care village

In helping to leverage the reach of aged-care pharmacists, the micro-videos on psychotropic use have already been warmly welcomed by sector professionals and aged-care workers who have long wanted to understand the complexities they have been tasked to tackle.

Merging macro-regulatory guidelines, with latest medical research, into bite-sized videos that pharmacists can use as educational guides in short handovers, is an important step to bridge the latest insight into the hands of those that need it most on the ground, “the videos cover important fundamentals of psychotropic medicine use – including appropriate initiation, monitoring and discontinuation of antipsychotics, antidepressants and benzodiazepines.”

Expanding from clinical leadership, the newest aged care workers must be supported in understanding psychotropic use as well. Cross notes, “I think this information is vital for all aged care workers. In addition to the videos, we also have a suite of resources such as one-page fact sheets, an adverse event monitoring tool, and a consumer companion guide translated into six different languages.” 

Cross also sees the videos as a vital resource for family members too, “[while] these resources can support conversations with prescribers, [they can] as well as with residents and families, and help aged care workers apply the core fundamentals in their practice.”

Organic uptake

Cross shares that it has been heartening to see the uptake and treasuring of the resources by people who have poured themselves into aged care work, “I’ve already shared the micro-learning videos with the staff at the aged care home I work at, and I know many of my aged care onsite pharmacist colleagues have similarly shared it with their homes.”

“We are really excited to have these new resources to support the conversations and education we are doing.”

Cross shares the professional hopes of the study and the resource solutions that have come out of them. Echoing many in the sector, to uplift, to upskill, to empower is at the heart of laying the foundation of a robust and resilient sector, that of a strengthened professional base tackling one of the most complicated areas of aged care, “I hope that these resources, particularly the micro-learning videos, can empower aged care workers to be advocates for appropriate psychotropic medication use and for their residents.”

“It would also be great to see these videos embedded in university pharmacy, nursing and medical degrees to equip the next generation of healthcare professionals.”

Continued collaboration

Cross highlights that continued collaboration is a needed ingredient to innovation, praticularly between aged care and academia. Partnership and grounded-insight is integral in pushing progress forward where it can impact most, on the ground, in facilities. 

Leveraging skills, insight and funding from all quarters means compounding success, “this work would not be possible without the input and support of dedicated project investigators and aged care provider partners. We collaborate closely to find solutions to everyday challenges.”

Continuing to look to further opportunities to improve and land reform, Cross exhorts, “any aged care provider interested in getting involved, we would love to hear from you.”