Thursday, 25 December 2014

Liverpool Care Pathway - A Seasonal Life Café

An Xmas Life Café and taking a different tack, changing the 'culture' of care...

Needs must but 'needs' require time and the care that time permits.

This is Life Café...

This is Shots from NPR –

Though antipsychotics are approved to treat serious mental illnesses like schizophrenia and bipolar disorder, the FDA says the drugs can increase the risk of death for people with dementia. Still, they're prescribed for nearly 300,000 nursing home residents nationally.

A few years ago, antipsychotics were used frequently at Pathstone, too.

"We saw these as medications that were supposed to help the patient and, of course, we gave them to them with the feeling that we were doing good," says Shelley Matthes, a registered nurse who is head of quality assurance for the nonprofit Ecumen, which runs Pathstone and about a dozen other nursing facilities in Minnesota.

Dr. Tracy Tomac is a psychiatrist and medical consultant at Pathstone. In the old days, a resident might have been started on antipsychotics to deal with an emergency, Tomac says, "but they would just stay on it. They would never be taken off for many months or even years."

"At the end of six months or so," Tomac says, "we were able to get them all off any antipsychotics. "The next year they extended the policy to all of Ecumen's nursing homes. "Our goal, Matthes says, "was to reduce our antipsychotic use by 20 percent. And in the first year we reduced it by 97 percent."

At Pathstone these days, around 5 to 7 percent of residents get antipsychotic drugs. Not all of the Ecumen nursing homes have numbers that low, but they're almost all well below the national average. And Matthes says the changes in the residents were as dramatic as the drop in the numbers."They started interacting," recalls Matthes, "and people who hadn't been speaking were speaking. They came alive and awakened."

Which is why they decided to call their program Awakenings.
Antipsychotics act like a chemical straitjacket. The recipient ceases to feel. This is often a complaint that is made. ‘Side-effect’ tablets often accompany the prescription. The depot may be accompanied by its own terrors.

The fear of advanced dementia and ending up in such an institution, dumbed down not to think, not to feel is also a terrible prospect. Such prospects will be considered when assembling the ACD or, in the US, the POLST. Nothing is that clear or simple.

This is Laurel Baxter, the Awakenings Project Manager -
“What’s people’s biggest fear? Being a ‘zombie’ in a nursing home.”
 This is from New York Times –

The woman, who was in her 90s, had lived for several years at the Ecumen Sunrise nursing home in Two Harbors, Minn., where the staff had grown accustomed to her grimaces and wordless cries. She took a potent cocktail of three psychotropic drugs: Ativan for anxiety and the antipsychotic Risperdal to calm her, plus an antidepressant. In all the time she’d lived at Sunrise, she hadn’t spoken. It wasn’t clear whether she could recognize her children when they came to visit.
The drugs can cause serious side effects. Since 2008, the Food and Drug Administration has required a so-called black box warnings on their packaging, cautioning that they pose an increased mortality risk for elderly patients. Nevertheless, a national survey reported that in 2004 about a quarter of nursing home residents were receiving antipsychotic drugs. (Among the antipsychotic drugs most commonly used in nursing homes are Risperdal, Seroquel and Zyprexa.)
Awakenings is a ‘hands-on’ approach.

With reduced medications, the woman at the Two Harbors home awoke.
She was able to speak — haltingly and not always understandably, but enough to communicate. And what she let Ms. Lanigan know, after years of being virtually nonverbal, was that she was suffering physical pain, the cause of her crying out. 
It took doctors a while to find effective medications for her nerve condition, but they were eventually able to make her more comfortable without further fogging her mind. She stopped taking psychotropic drugs altogether.
A Will to live and the commitment to care, not the ACD pushed by the pedlars of despair: this is the message of this Life Café. 

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