The PBAR Protocol: Antipsychotic Medication Reduction in the Nursing Home

Neuropsychiatric symptoms (NPS) occur in almost all persons living with dementia. Antipsychotic medications are often prescribed inappropriately for persons living with dementia who experience NPS. Adverse side effects of antipsychotic medications include falls, sedation, cognitive dysfunction, prolonged QTc interval, extrapyramidal side effects, cerebrovascular events, metabolic changes, infection, and mortality. The purpose of this descriptive quality improvement project was to test the feasibility and preliminary effectiveness of using the Psychiatric Background Assessment Recommendation (PBAR) Interprofessional Communication Tool (ICT). The PBAR-ICT was adapted from the Situation Background Assessment Recommendation (SBAR) Protocol by the Principal Investigator and was used to report critical NPS in the nursing home. After approval from the university institutional review board, an education program on identifying NPS was provided to the nursing staff. The education program focused on using terminology to destigmatize and standardize NPS. Training was also provided on how to use the PBAR-ICT. A six-month retrospective and prospective chart review were completed on all charts documenting an antipsychotic medication prescription. Medication changes were analyzed to determine successful or unsuccessful deprescribing by comparing data on pre and post PBAR-ICT implementation. Chart diagnoses (n=104) included dementia (n=55), schizophrenia/bipolar disorder (n=14), schizophrenia/bipolar disorder plus dementia (n=23) or no documented diagnoses (n=12). Relative to pre PBAR-ICT implementation for all charts (n=104), results on post PBAR-ICT implementation estimated 1.57times higher odds (p=0.003) for decreasing and/or discontinuing antipsychotic medications. Outcomes on post PBAR-ICT implementation were analyzed by diagnoses. When compared with the schizophrenia/bipolar disorderplus the dementia group, successful discontinued/decreased antipsychotic medications were statistically significant (p=0.015) for the dementia only group. Results of this quality improvement project demonstrated the feasibility of implementing the PBAR-ICT in the nursing home. The PBAR-ICT is an interprofessional communication tool that can play a role in communicating NPS to discontinue and decrease antipsychotic medications.