Prior to QMR

• Review the Quarterly Medication Review Deprescribing Focus – Antipsychotic Use in BPSD
• Determine when and why the antipsychotic was started. Document this information on the QMR form adjacent to the antipsychotic medication the resident is using
• Refer to Table 4 “Indication Based Criteria for Deprescribing Antipsychotics” (on page 5) to assess for deprescribing

During the QMR

• For situations where deprescribing can be considered, refer to the deprescribing.org resources for guidance on deprescribing antipsychotic medications:
  • Antipsychotic deprescribing algorithm⁵
  • Antipsychotic deprescribing guideline information pamphlet
  • Antipsychotic deprescribing infographic
  • Whiteboard video on using the Antipsychotic Deprescribing Algorithm (10 mins)
• If the antipsychotic was prescribed for BPSD and has been used for less than 3 months:
  • Determine if there has been objective improvement in the targeted behaviour(s) using behaviour mapping or DOS
  • Review for any changes in functioning (e.g. increased fall rate, somnolence, increased cognitive decline)
  • Assess for the emergence of any adverse effects (refer to the Antipsychotic Side Effects infographic)
  • Deprescribe if there is no improvement in behaviour and/or the risks outweigh the benefits
• For indications where the antipsychotic medication is warranted and should not be deprescribed:
  • Assess for treatment effect and/or the emergence of adverse effects (refer to the Antipsychotic Side Effects infographic)
  • Assess if consulting a specialist (e.g., RACE Psychiatry) is required in order to optimize the treatment and if deprescribing or switching to an alternate medication is warranted (e.g., if adverse effects are occurring or treatment is not effective)