Understanding the Risks and Benefits of Medical Cannabis Use for Individuals with Dementia Living in Long Term Care
Summary
Over the past decade, medical cannabis has moved to the forefront with growing application to older adults with dementia (Ahmed et. al, 2015). It is believed that older adults with cognitive changes have multiple co-morbidities and would benefit from the use of medical cannabis as a multidrug target (Ahmed et. al, 2015). Research has outlined the benefits medical cannabis has on resident care but the long term effects of medical cannabis use are not well understood (Katz et al., 2017). The purpose of my Advanced Clinical Practice Fellowship (ACPF) was to further understand the benefits and risks of medical cannabis use for individuals with dementia living in long term care. The knowledge obtained has enhanced my clinical practice and ability to support the knowledge of staff in the home.
The practice setting of my fellowship took place at The Wexford Residence which is a long term care facility in Scarborough, Ontario. My mentorship team included: the in-house Nurse Practitioner, Coordinator of Behavioural Support, Pharmacy Consultant as well as the Pain and Palliative Symptom Consultant (PPSMC). The target population for my fellowship are residents with dementia living in long term care. The Wexford's dementia rate is approximately 75% which makes my employer an ideal location to explore the topic of interest.
The interdisciplinary team has questioned the relationship between pain management and responsive behaviour patterns. With a progressive and supportive medical team, it was determined that exploring the area of medical cannabis use for residents with dementia would be beneficial. Currently there are no residents at The Wexford Residence taking medical cannabis for therapeutic purposes. With application of the ACPF activities, it is believe that there is the potential to increase use of medical cannabis in the home with the right amount of research, education, and interdisciplinary discussion.
Objective #1 - Demonstrate understanding of medical cannabis use in long term care. This learning objective required extensive review of the literature to look for trends of cannabis use among the geriatric population. The knowledge obtained was a catalyst to the approach that would be used to educate staff and family on the risk and benefits of cannabis use in long term care. My research and synthesizing skills were refreshed to ensure a robust amount of information was presented in a logical easy to comprehend way.
Objective #2 - Demonstrate understanding of the difference between pain and behaviour management assessment tools. Through reviewing the validated clinical tools used in the home a better understanding of how residents are assessed was gained. A crucial part of reviewing assessment documents was to ensure staff understand how to properly assess a resident’s behaviour and pain before requesting cannabis for medical purposes. The expertise obtained was supported by the Behavioural Support Nurse who also supports the assessment skills of staff.
Objective #3 - Recognize and address the clinical learning needs of registered staff. Providing relevant factual information assisted staff in recognizing their own clinical bias as well as how cannabis can impact the geriatric population. The education supported the nurses to ask questions and assess the risks and benefits of cannabis use in a long term care setting. The knowledge, skill and expertise gained from learning objective #1 and #2 were tested and successfully applied through this learning objective.
Objective #4 - Support family member’s knowledge of medical cannabis use in long term care. Similar to providing education to staff, providing education to family was essential to ensure information is relevant and factual. Reviewing the home’s policy and expectations ensured families understood what the home’s obligation for cannabis in long term care as it aligns with public policy. The expertise that was gained was becoming a knowledge broker for family members as many of them did not have prior knowledge of cannabis.
Outcomes
Objective #2 – Material from the P.I.E.C.E.S model was reviewed to support holistic care planning for residents who wish to use cannabis for therapeutic purposes. The internal policy and P.I.E.C.E.S model was reviewed and BSO Coordinator was consulted on her perspective of use of medical cannabis for behaviours. An Individual’s current plan of care was reviewed and the potential for the individual to be admitted with cannabis use was discussed. Feasibility was explored on the notion of the individual vaping independently as there were some conflicts with the home’s internal policy.
Objective #4 – A multi-part education series for family members (supported by the Nurse Practitioner) was developed and the first session was conducted as part of the fellowship at the Family Liaison Council meeting. Educational materials were shared electronically to all members of the council. Family members were engaged and participated throughout the education session. Information that was provided was well received.
Objective #1 - A scholarly review of the literature was completed reviewing the use of cannabis in long term care. The document was made available to registered staff interested in learning more about the use of cannabis in the geriatric population.
Objective #3 - A pre-questionnaire was administered to registered staff to assess their knowledge level of cannabis use in long term care. Education was tailored to address the 10 items outlined in the pre-questionnaire plus ignite conversation on the risks and benefits of cannabis in long term care. The results of the post-test indicated that staff understood the content of the education session. Aspects of the internal policy as well as expectations from the College of Nurses were reviewed as part of the education session. The education established a foundation for future education sessions on cannabis use in long term care.
Overall experience
The opportunity of completing an ACPF was a very exciting and unique experience. As a Coordinator of Staff Development and Quality Improvement Facilitator I enjoy researching and gaining knowledge on a variety of topics. The utilization of cannabis in long term care is a topic that is not well understood with little quantitative data to support practice. Many hours were spent reading through cannabis related research as well as clinical trials of cannabis. The knowledge gained was invaluable as it provided a foundation of how to best approach the introduction of cannabis into The Wexford Residence. Working alongside my primary mentor (Ciera Cook - RN (EC), NP-PHC, MN, BScN, IIWCC(C)) allowed me to have assurance that my clinical findings were appropriate and applicable to long term care. The learning opportunities that I engaged in encouraged me to discuss the use of cannabis with other health care professionals outside of the nursing discipline. I was able to attend a cannabis workshop in Toronto, the OLTCA-This is LTC conference in Toronto and the Geriatric Education Series in Ottawa.
Completing the final two objectives of my learning plan was the most memorable. Being able to share the knowledge gained throughout my ACPF with family members and staff was satisfying knowing the contribution I had made to my employment setting. It was interesting to complete an ACPF at my current work location because it allowed me to observe practice outside the perspective of an educator role. The knowledge, skill and expertise gained from this experience has not only supported my own practice but those around me. I believe the foundation I have established will allow the home to support and educate staff and family on the use of cannabis in long term care. With the conclusion of the fellowship, I anticipate my knowledge will continue to develop and I will remain an active participant in the development of cannabis use at The Wexford Residence.
