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Quality Improvement

Choosing Wisely in Long-Term Care

Ontario’s provincial priority for Choosing Wisely Canada in the long-term care sector focuses on appropriate prescribing with respect to antipsychotic use, diabetes care and asymptomatic bacteriuria. These recommendations are broad applicability across Ontario’s long-term care homes and can significantly impact patient outcomes.

 

Appropriate prescribing of antipsychotics

People with dementia often exhibit aggression, resistance to care and other challenging behaviours. In such instances, antipsychotic medicines are often prescribed, but provide limited benefits and can cause serious harm. The use of these drugs should be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others.

Long-term care sector anti-psychotic prescribing recommendations:

  • Don’t use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia

Resources to help choose when to prescribe anti-psychotics wisely:

 

Appropriate prescribing of diabetes medications

There is no evidence using medications to achieve intense glycemic control in older adults with type 2 diabetes is beneficial. Given the long timeframe of approximately eight years to achieve the theorized benefits of intense glycemic control, a patient’s targets should reflect the individual’s goals, health status and life expectancy.

Long-term care sector diabetes medication prescribing recommendations:

  • Avoid using mediations known to cause hypoglycemia to achieve hemoglobin A1c,7.5% in many adults age 65 and older; moderate control is generally better

Resource to help choose diabetes medications wisely:

 

Appropriate prescribing for asymptomatic bacteraemia

Asymptomatic bacteriuria is the presence of bacteria in the urine without causing symptoms. Studies have found no adverse outcomes for older men or women related to asymptomatic bacteriuria. Antimicrobial treatment studies for asymptomatic bacteriuria in older adults demonstrate no benefits and show increased adverse antimicrobial effects.

Long-term care sector asymptomatic bacteraemia prescribing recommendations:

  • Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present

Resources to help choose asymptomatic bacteriuria treatment wisely:

 

Ready to bring Choosing Wisely to your long-term care practice?

If you have a question about Choosing Wisely Canada or want to learn more about how to get involved, please email us at CWC@hqontario.ca.

 

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