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Clear

Clear is supporting long-term care homes to reduce the number of their residents who are prescribed antipsychotic medications. This is the third wave of Clear, and this time we’re focused on supporting care homes that have more residents receiving antipsychotics without a diagnosis of psychosis than the BC average of 25%.

Wave 3 of Clear launched in December 2017 and is currently underway, with 41 participating care homes.

Learn how Clear is supporting care homes to reduce antipsychotics

Topic Status: Active


Wave 3 Teams

Are you an Action & Improvement Team participating in Wave 3? Here’s all the resources you need.

Webinar Recording: Capturing PDSAs in Your Spreadsheet

Watch this 3 minute video diving into how the Clear measurement tool can be used to track PDSAs.

Watch the recording

 

Blank Clear Data Collection tool

An Excel template teams will be using for tracking progress.
Download the tool

 

Sample Clear Data Collection tool

A sample Excel template that is pre-filled with data for reference.
Download the sample

 

Webinar Recording: Measurement & Data Collection Tool

Watch a one-hour recorded webinar covering measurement and demonstrating the Data Collection Tool.
Watch the recording

 

Data Collection User Guide

A step-by-step guide on how to use the Data Collection Tool
Download the guide

 

Measurement Plan Worksheet

A two-page worksheet to help teams prepare for data collection.
Download the worksheet

 

Measurement Strategy

This document outlines for Action & Improvement Teams how data are collected and used over the course of the initiative.
Download the strategy

Driver Diagram

This document provides suggested strategies and changes to reduce antipsychotic medications in long-term care.

Download the driver diagram

 

High Impact Changes

This document is a Driver Diagram addendum and features change ideas that may be particularly impactful in long-term care homes.
Download the changes

 

Process Improvement Charter

Define the scope, approach, resources and timeline of your improvement project.
Download the charter

 

Stakeholder Engagement Planning Form

Identify who you will need to engage in your improvement project and how to do so.
Download the form

 

PDSA Testing Ideas Worksheet

Plan-Do-Study-Act Cycles help you test all of your change ideas. Use this worksheet to plan your tests.
Download the worksheet

 

When Psychosis Isn’t the Diagnosis: A Toolkit for Reducing Inappropriate Use of Antipsychotics in Long Term Care

This toolkit supports interventions to reduce the excessive use of antipsychotic medications in long term care homes.
Download the toolkit

Culture Change Toolbox

A collection of tools and interventions for changing culture, each one accompanied by tips on how to apply it.
Download the toolbox

 

Quick Guide to Completing Monthly Reports

Action & improvement teams are expected to complete a monthly team report at the end of each month.
Download the guide

 

Appropriate Use of Antipsychotics Toolkit for Care Teams

The Alberta Guideline on the Appropriate Use of Antipsychotic Medications (2013) and accompanying resources provide health care professionals with direction regarding assessment and management of responsive behaviours associated with dementia.
Download the toolkit

Dose Reduction Template

The Dose Reduction Template has been developed to facilitate communication with your physician about reducing antipsychotic use for a specific individual with BPSD.

This template is:

  • Part of a conversation – think of this template as part of your developing relationship with your physicians. This is to support your relationships and communication with physicians.
  • A prototype – we would love to keep working on this template with you! If you have changes you would like us to make to the letter, please do!
  • Aimed at general practitioners – if you have a geriatric psychiatrist or equivalent, you may want to customize this process to meet their needs.

Watch our 4 minute clip where we walk you through completing the template. We’ve provided it in Word format, so please feel free to personalize the template for your use. To provide feedback on the form, contact clearbc@bcpsqc.ca.

Access the template Watch the Recording

Physician Template Letter

The Physician Template Letter has been developed to facilitate communication about your Clear work between teams and your physicians and as a starting point for engaging physicians on an individual level.

We’ve provided it in Word format, so please feel free to add additional information about your site, your team’s approach and your team. To provide feedback on the form, contact clearbc@bcpsqc.ca.
Access the letter

BPSD Algorithm

The BC BPSD Algorithm is a practical, electronic and interactive tool that supports interdisciplinary, evidence-based, person-centred care for persons with behavioural and psychological symptoms of dementia (BPSD).

It is very simple to use and completely mobile-friendly – meaning that you can use it on your smartphone, tablet or laptop.
Access the algorithm

Practice Recommendations for Initiation, Titration and Tapering of Antipsychotic Medications

This decision support tool helps guide clinicians to initiate, titrate, reduce and monitor antipsychotic medications and is a resource meant to accompany the BC BPSD Algorithm.
Access the tool

A Dementia Roadmap for Practitioners

A roadmap for outlining the stages of dementia – symptoms, sign-posts, good questions and tasks for the practitioner.
View the roadmap

Maximizing Success when communicating with someone with Dementia

We communicate verbally, non-verbally and through written words. In order for communication to occur, the message that is transmitted must be interpreted and understood. Unfortunately, when an individual has been diagnosed with a type of dementia, the communication process is affected. This often leads to misunderstandings and frustration from both the individual with dementia and the caregiver. This webinar detailed some very important strategies to keep in mind in order to effectively communicate with an individual diagnosed with dementia.
Watch the webinar

Dementia – Understanding and Managing Challenging Behaviour

If you are someone looking after a family member with dementia in your own home or a professional working with people with dementia, this free online course will help you better understand the person and develop the skills needed to manage their challenging behaviour.
Access the course

Best Practice Guideline for Accommodating and Managing Behavioural and Psychological Symptoms of Dementia in Residential Care

This guideline was developed in response to “A Review of the use of Antipsychotic Drugs in British Columbia’s Residential Care Facilities” conducted by BC’s Ministry of Health in 2011.
Access the guideline

Guidelines for the Recognition, Diagnosis and Management of Cognitive Impairment

This guideline provides recommendations for adults ≥ 19 years within the primary care setting. It focuses on Alzheimer’s disease, the most common form of dementia seen in primary care. The guideline encourages early recognition and assessment of dementia and supports the development of a care plan that includes the identification of community resources for patients and caregivers.
Access the guidelines

Putting the PIECES Together in the Health Care Maze

A story illustrating the benefits of the PIECES (Physical, Intellectual, Emotional, Capabilities, Environment, Social) framework, a tool created in Canada for those who work with older adults who have complex health issues.
Read the article

You Decide Sheet for Antipyschotics in Treatment of BPSD in Elderly

Shared Care’s Polypharmacy Risk Reduction Initiative created this evidence-based summary which has been reviewed by an expert clinical advisory group to inform medication reviews and decision making
Download the sheet

Best Practices Guide for Safely Reducing Anti-Psychotic Drug Use in Residential Care

The BC Care Providers Association (BCCPA) has developed this Best Practices Guide to help long-term care providers reduce the use of anti-psychotic drugs in their residential care homes.
View the guide

“It’s Your Medicine, What Shall We Do With It?”

The Health Foundation published a short video about a medication review project in the UK that “brings together care home residents, their families and health professionals to ensure residents are getting the right mix of medications.” Among the project’s achievements is reducing the amount of medicine prescribed to residents by 17%.
Watch the video

Swindon’s Great Western Hospital Gets Dementia Friendly Ward

Discreet adaptations, such as clocks that help patients distinguish between night and day and a matte finish floor to reduce falls, have been made.
View more information

World Alzheimer Reports

These annual reports examine global trends related to older people who need dementia care, including those with Alzheimer’s disease.
Download the reports

How the NHS has Addressed Dignity in Residential Care – Pecha Kucha-Style

On March 6, 2012, Helen Bevan, chief of service transformation at the NHS Institute for Innovation and Improvement, spoke at Health Talks. She used a Pecha Kucha presentation to describe how the National Health Service has addressed dignity in residential care.
Watch the video

‘Dementia-Friendly Communities’ and Being Dementia Friendly in Health Care Settings

This review discusses the concept of ‘dementia-friendly communities’ and summarizes the latest research and practice around such communities. This review also highlights important topic areas to be considered to promote dementia friendliness in healthcare settings.
Read the review

Home Recreates Past for Dementia Patients

Watch a video about a Georgian Bay, Ontario retirement home that has carefully recreated the past for dementia patients who find the environment comforting.
Watch the video

Physicians

BPSD Algorithm

The BC BPSD Algorithm is a practical, electronic and interactive tool that supports interdisciplinary, evidence-based, person-centred care for persons with behavioural and psychological symptoms of dementia (BPSD).

It is very simple to use and completely mobile-friendly – meaning that you can use it on your smartphone, tablet or laptop.
Access the algorithm

Practice Recommendations for Initiation, Titration and Tapering of Antipsychotic Medications

This decision support tool helps guide clinicians to initiate, titrate, reduce and monitor antipsychotic medications and is a resource meant to accompany the BC BPSD Algorithm.
Access the tool

When Psychosis Isn’t the Diagnosis: A Toolkit for Reducing Inappropriate Use of Antipsychotics in Long Term Care

This toolkit supports interventions to reduce the excessive use of antipsychotic medications in long term care homes.
Download the toolkit

A Dementia Roadmap for Practitioners

A roadmap for outlining the stages of dementia – symptoms, sign-posts, good questions and tasks for the practitioner.
View the roadmap

Guidelines for the Recognition, Diagnosis and Management of Cognitive Impairment

This guideline provides recommendations for adults ≥ 19 years within the primary care setting. It focuses on Alzheimer’s disease, the most common form of dementia seen in primary care. The guideline encourages early recognition and assessment of dementia and supports the development of a care plan that includes the identification of community resources for patients and caregivers.
Access the guidelines

Putting the PIECES Together in the Health Care Maze

A story illustrating the benefits of the PIECES (Physical, Intellectual, Emotional, Capabilities, Environment, Social) framework, a tool created in Canada for those who work with older adults who have complex health issues.
Read the article

You Decide Sheet for Antipyschotics in Treatment of BPSD in Elderly

Shared Care’s Polypharmacy Risk Reduction Initiative created this evidence-based summary which has been reviewed by an expert clinical advisory group to inform medication reviews and decision making
Download the sheet

Best Practices Guide for Safely Reducing Anti-Psychotic Drug Use in Residential Care

The BC Care Providers Association (BCCPA) has developed this Best Practices Guide to help long-term care providers reduce the use of anti-psychotic drugs in their residential care homes.
View the guide

“It’s Your Medicine, What Shall We Do With It?”

The Health Foundation published a short video about a medication review project in the UK that “brings together care home residents, their families and health professionals to ensure residents are getting the right mix of medications.” Among the project’s achievements is reducing the amount of medicine prescribed to residents by 17%.
Watch the video

Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide

This tool is designed to help providers understand, assess, and manage residents in LTC homes with behavioural and psychological symptoms of dementia (responsive behaviours), with a focus on antipsychotic medications. It was developed as part of Centre for Effective Practice’s Academic Detailing Service for LTC homes. This tool integrates best-practice evidence with clinical experience, and makes reference to relevant existing tools and services wherever possible.
Download the tool

Agitation in Dementia: Quantifying the Effects of Antipsychotics

This document answers the question: What are the benefits and harms of antipsychotics for agitation in dementia?
Download the document

Evidence Summary: Antipsychotics in the Treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) in the Elderly

Most people with dementia will experience BPSD at least once during the course of their disease. The focus of this document is on the behavioural component.
Download the summary

Families & Caregivers

When Your Loved One Has Dementia – A Roadmap for Families

While different kinds of dementia vary in their initial presentation and rate of progression, there are features of the dementia “journey” common to all. This brochure is a basic “roadmap” of the territory, to help families orient themselves on the journey their loved on is travelling, and see what’s coming farther along the road.
Download the brochure

All About Me: A Booklet About a Person Living with Alzheimer’s Disease or Other Dementia

All About Me is a resource for people with dementia to tell health care providers about themselves – their needs, likes, dislikes and interests – so that the providers can build relationships with them and support personalized care.
Download the resource

Shifting Focus- A Guide to Understanding Dementia Behaviour

This booklet is meant to help family members, friends and co-residents of those who live at home or in a long-term care home and are behaving in unpredictable ways that create unease or distress. It helps care partners and fellow residents to learn about the brain and how dementia affects it; recognize your family member’s actions and their meaning; offer ways to respond; and increase patience and acceptance for those living with a dementia.
Download the booklet

Dementia – Understanding and Managing Challenging Behaviour

If you are someone looking after a family member with dementia in your own home or a professional working with people with dementia, this free online course will help you better understand the person and develop the skills needed to manage their challenging behaviour.
Access the course

Living with Dementia

This brutally honest film reminds us that although dementia causes the loss of some abilities, people’s feelings remain intact. Four people with dementia talk about their emotions: fear, guilt, embarrassment, isolation, powerlessness. The film also shows the difference a supportive, empathetic relationship can make.
Watch the film

‘Dementia-Friendly Communities’ and Being Dementia Friendly in Health Care Settings

This review discusses the concept of ‘dementia-friendly communities’ and summarizes the latest research and practice around such communities. This review also highlights important topic areas to be considered to promote dementia friendliness in healthcare settings.
Read the review

Home Recreates Past for Dementia Patients

Watch a video about a Georgian Bay, Ontario retirement home that has carefully recreated the past for dementia patients who find the environment comforting.
Watch the video

How Antipsychotic Medications are Used to Help People with Dementia

As a member of the care team, you have an important role to play in helping the health care providers decide whether this treatment is a good choice for your family member or friend. This guide will help you learn more about how antipsychotic medications are used to help people with dementia.
Download the guide


Reports from Waves 1 & 2

Wave 2 Report

40 care homes participated in Wave 2 and made a tremendous impact – reducing or discontinuing antipsychotics prescriptions for 1,001 residents. Other key takeaways include:

  1. Decreased use of antipsychotic medication
  2. Improved quality of life for residents
  3. Built capacity for quality improvement
  4. Increased resident care planning for quality of life and safety
  5. Decreased residents on antipsychotics without a diagnosis of psychosis
  6. Increased use of best practice management for residents with BPSD
  7. Improved culture by enhancing teamwork and communication in workplace and workflow
  8. Changes resulting from CLeAR are considered sustainable
Download the report

Wave 1 Report

This report features summary results from the first wave of CLeAR, which featured 48 participating care homes and ran from October 2013 to December 2014.

Action & Improvement teams made significant progress towards their goals by adapting existing knowledge to their own environments, with many individual homes seeing dramatic reductions in their use of antipsychotic medications.

The report shares results and learning from the initiative, and celebrates success and progress made by improvement teams across the province.

Download the report