Study: Training SNF staff to recognize residents' unmet needs helps cut antipsychotic use

The OASIS program focuses on "treating the residents as human beings with needs, not as patients with problems," Tija says.
The OASIS program focuses on "treating the residents as human beings with needs, not as patients with problems," Tija says.

A training program that teaches nursing home staff better understand cognitively impaired residents' behavior may help reduce the use of antipsychotic medications within facilities, according to a new study.

Researchers with the University of Massachusetts Medical School set out to assess the impact a communication-focused training program, dubbed “OASIS”, could have on nursing facilities' off-label antipsychotic use. The team's findings were published Monday in JAMA Internal Medicine.

OASIS, developed by the Massachusetts Senior Care Association and the Massachusetts Department of Health, helps workers such as nursing assistants, nurses and dietary staff identify residents' challenging behaviors through the lens of unmet needs. Those needs range from physiological, such as food and comfort, to safety and social needs.

“The OASIS program asks nursing staff to create care plans that include what residents can do, shifting away from the model that focuses on what they can't do,” said lead researcher Jennifer Tija, M.D., MSCE, an associate professor at UMass.

The study — the largest of its kind thus far — compared antipsychotic use in nearly 100 Massachusetts nursing homes that used the OASIS program from 2011 to 2013, to more than 800 other facilities in the state and in New York that were not enrolled in OASIS.

Antipsychotic use dropped from 34% to 27% after nine months for facilities that used the OASIS program, compared to 23% to 19% at the non-OASIS facilities. The reductions didn't continue during the post-program maintenance phase, researchers found.

The reduction in the OASIS facilities is notable, researchers said, since the program focuses on frontline staff, not prescribers.

“This is the largest study to show that it is possible to reduce antipsychotic use in the nursing home population,” Tija said. “This intervention focused on treating the residents as human beings with needs, not as patients with problems.”