Lessons from a multi-strategic program to promote appropriate sedative use in residential aged care facilities

Within Residential Aged Care Facilities (RACFs), the use of sedatives, predominantly antipsychotics and benzodiazepines, is highly prevalent, often prescribed for the treatment of Behavioural and Psychological Symptoms of Dementia (BPSD), anxiety and nocturnal disruption. However, evidence only shows a modest benefit of using antipsychotics in the treatment of BPSD; and benzodiazepines lose effectiveness after sustained use. Both drug classes are associated with significant risks, including falls, confusion, and death. To encourage the appropriate use of these medications, the Reducing the Use of Sedatives (RedUSe) program is being run in 150 Australian RACFs, employing multiple strategies: audit and feedback, an interdisciplinary sedative review process, and staff education. Results of the program to show unexplained variations between RACFs in sedative prevalence reduction. By understanding the variations in sedative prevalence reduction and assessing the implementation of the program in RACFs, there is the potential to identify why some RACFs responded more strongly to the program and thereby improve future programs. We aim to investigate the reasons for the variations in sedative reduction between RACFs and the factors influencing the implementation of the RedUSe program which include medication outcomes, organisational features, and the perspectives of key personnel. This paper reports the mixed methods (quantitative and qualitative) of this study. Quantitative methods include multivariate analyses based on medication use and organisational properties of RACFs, and analysis of RACF organisational culture by surveying RACF personnel. Qualitative methods are based on content analysis of structured interviews with RACF prescribers, pharmacists, nurses, care workers, and management. Emerging themes from the interview data are validated by member-checking, on-site observations, and expert-panel discussion. A thorough examination of the factors influencing the implementation of this program will enable its enhancement and facilitate greater understanding of the barriers and enablers to reducing sedative medication when utilising a dedicated implementation program.