Barriers and facilitators to implementing strategies for reducing inappropriate antipsychotic use in long-term care: a scoping review

Inappropriate use of antipsychotics negatively affects the quality of life of residents in long-term care (LTC). Despite efforts to reduce inappropriate antipsychotic use, understanding of how to implement antipsychotic reduction strategies remains limited. This scoping review explores: (1) the types of effective non-pharmacological strategies used to reduce antipsychotic use in LTC, (2) barriers to their implementation, and (3) facilitators supporting their implementation. Following the guidelines of the Joanna Briggs Institute, we synthesize existing evidence. A three-step search strategy was conducted across databases for publications from January 2014 to September 2024. Data extraction was thematically analyzed and subsequently compared with the Consolidated Framework for Implementation Research (CFIR) for further insights. The review team comprised diverse stakeholders, including patient and family partners, and healthcare providers. The review identified three main types of strategies with positive outcomes: person-centred care and environmental adaptation, medication review and monitoring, and regulatory measures, with education and training cutting across these strategies. Key implementation barriers included staff and family resistance, poor team coordination and communication, and challenges with staffing and training, which could be addressed by related facilitators: cultural shifts, a cohesive team approach, and improvements to staffing and training. Beyond those addressing specific barriers, additional facilitators included increased accountability and the use of multifaceted approaches. Findings underscore the need for comprehensive, integrated approaches that combine clinical, organizational, and educational strategies to overcome implementation challenges. Future initiatives should prioritize team-based coordination and engagement from staff, families, and leadership.