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many reasons for residents having trouble settling, restlessness, anxiety, or verbal and physical aggression. These include: an uncomfortable
bed, room temperature, individual sleep times, constipation, pain, or just a need for reassurance. These are often difficult to assess due to limited communication in people with dementia. Understanding the individual’s personal situation may help reduce medication use. The pharmacist may have a role in encouraging staff to make these individual assessments.
RedUSe study
RedUSe was great a initiative and six of my facilities benefited from it. Even greater success could be achieved with more education and training for GPs and ACF Managers.1 I have seen a direct relationship between reduction in sedative use and the views
of the General Manager or Director of Nursing. The attitudes of RNs towards sedative reduction are a factor but for full success management co-operation is critical.
Sedative use audits
Sedative use audits discussed in medication advisory committee meetings often focus on discussing trends and benchmarks. The concrete
next actions for continuous improvement based on the report may be unclear and a pharmacist can have significant input and involvement in initiating action.
“To reduce sedative use, it is necessary to understand each resident’s individual story. There may be
many reasons for residents having trouble settling, restlessness, anxiety, or verbal and physical aggression.”
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Weaning off sedatives
Any change in behaviour pattern after dose reduction or weaning off sedatives is scrutinised closely. The staff, GPs and management need
to be motivated and aware that there may be a slight increase in behaviours with weaning, which may settle over time. Documentation of changes
in behaviour with commencing and ceasing of medication needs to be quantified. Pharmacists can have a role in explaining to staff about monitoring for adverse effects and follow up when a medication is commenced or ceased.
Reference
1. UMORE. The RedUSe project. at: https://www.pharm.utas.edu.au/reduse
Australian Pharmacist January 2017 I ©Pharmaceutical Society of Australia Ltd. 21
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