Rural nursing homes lack drug oversight

Hey there, time traveller!
This article was published 15/06/2015 (3764 days ago), so information in it may no longer be current.

The Manitoba government admits it has no way of tracking the level of antipsychotic drug use in nursing homes outside of Winnipeg.

The Free Press reported Saturday hundreds of Winnipeg personal care home residents are being prescribed the drugs — even though they have not been diagnosed with a psychotic disorder such as schizophrenia.

The off-label use of these drugs is a national concern.

While the Winnipeg Regional Health Authority tracks the prescribing of antipsychotic drugs in each personal care home — and has set targets to reduce their use — there is little oversight outside the Perimeter Highway, the Free Press has found.

“At this point, the levels of anti-psychotic drugs in rural nursing homes are not yet tracked centrally or available as easily in rural regions,” said a government spokeswoman.

The province has asked the Manitoba Centre for Health Policy to help create a reporting standard across all regional health authorities on the use of antipsychotic medications and other performance indicators in personal care homes, the spokeswoman said in an email.

“This will build on the existing WRHA system, but it takes time to plan for future upgrades and implementation across the long-term care system,” she said.

The WRHA has been tackling the issue of non-label uses of antipsychotic drugs for some time. An average of 21 per cent of city nursing-home residents are on the drugs, compared with about 30 per cent nationally.

In two city care homes — Oakview Place and Riverview Health Centre — as many as one in three residents is being prescribed these medications.

The WRHA would like to reduce usage citywide to between five and 15 per cent.

Experts say some off-label use of antipsychotics such as risperidone and olanzapine, which are used to treat schizophrenia, may be warranted, but the level of use in many Canadian nursing homes is too high.

According to the Canadian Geriatrics Society, the drugs provide limited benefit to dementia patients and can cause serious harm, including premature death. It says their use should be limited to cases where other methods of managing residents have failed and patients pose an imminent threat to themselves or others.

While the WRHA appears to have a handle on the situation in Winnipeg, there is no central authority keeping track of antipsychotic use in rural care homes.

Blaine Kraushaar, a spokesman for Prairie Mountain Health, which takes in Brandon and a large part of western Manitoba, suggested the Free Press file a freedom-of-information request when it sought information earlier this year on the extent of antipsychotic drug use in nursing homes there.

‘At this point, the levels of antipsychotic drugs in rural nursing homes are not yet tracked centrally or available as easily in rural regions’

Kraushaar said that would allow the health region’s privacy officers “to be able to ascertain what data we have available… and within what time frame and at what cost.”

Maria Siemens, a spokeswoman for Southern Health, which takes in such communities as Steinbach, Portage la Prairie, Morden and Winkler, said in an email the region “does not capture/compile/report on this data at this time.”

The Interlake-Eastern Regional Health Authority also lacks detailed information on antipsychotic drug use in its care homes, but it has begun to train staff to develop strategies to minimize the need for the medications.

Cynthia Sinclair, personal care home program manager, said she assumes 30 per cent of residents in the region’s 16 nursing homes are prescribed the drugs. She also suspects there are wide variations within individual homes.

Sinclair previously worked on programs to reduce the use of antipsychotics in Winnipeg. She is now taking this effort to care homes north and east of the city.

At each facility, she works with staff intensively for three to four months. The focus is on getting staff to know residents with dementia better and looking for creative ways to manage their behaviour while reducing or eliminating the use of antipsychotic drugs.

“Our opinion is that there’s always room for improvement, and we want to make sure that when we’re using these medications, they are being used appropriately,” Sinclair said.

larry.kusch@freepress.mb.ca