Exploring quality improvement processes for psychotropic medication use in Australian residential aged care homes: a qualitative study.

Abstract

Background: Recent regulatory changes in Australia have emphasised system-level approaches to ensure appropriate psychotropic medication use in residential aged care homes. This study explored quality improvement processes related to psychotropic medication use in Australian residential aged care homes.

Methods: This qualitative study used in-depth semi-structured interviews with a maximum variation sample of key stakeholders involved in psychotropic medication use at organisations operating facilities in metropolitan and regional areas in four Australian states. The interviews were transcribed verbatim and thematically analysed using both inductive and deductive approaches by two researchers using a framework developed for learning health systems.

Results: Stakeholders (n = 33) included nurses, occupational therapists, pharmacists, medical practitioners, residents and caregivers. Identified themes were (i) regulation was driving change in organisational policies and procedures, and (ii) aged care organisations were enhancing quality improvement systems for psychotropic medications. Many of the requirements of successful healthcare quality improvement systems were present within the aged care organisations, including alignment of core values and presence of key ethical, legal and policy infrastructure. There are opportunities for better use of clinical data to improve care, especially in terms of learning from the data and implementing tailored change. The challenges identified by participants included navigating the perceived tension between compliance and quality, and aligning the goals and processes of all health professionals.

Conclusions: Recent changes in policies, procedures and infrastructure have provided clearer oversight of psychotropic medication use. Individual and system approaches to psychotropic medication use in aged care have shifted. Key opportunities for improving use of psychotropic medications within aged care organisations include improving the capacity to use local data to improve care and building interdisciplinary teams to facilitate collaborative care.