Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program (original) (raw)
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BMC Geriatrics
Background: Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional cooperation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR' health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists' medication reviews linked with measures to strengthen interprofessional cooperation on NHR' medication quality, health status and health care use. Methods: Pragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist's medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a "toolbox" to facilitate implementation in daily practice. Analysis: primary outcome-proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes-cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs. Discussion: The trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany. Trial registration: Registered in the German register of clinical studies (DRKS, study ID DRKS00013588, primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.
BMC Geriatrics, 2019
BackgroundUncoordinated interprofessional communication in nursing homes increases the risk of polypharmacy and inappropriate medication use. This may lead to augmented frequency of adverse drug events, hospitalizations and mortality. The aims of this study were (1) to improve interprofessional communication and medication safety using a combined intervention and thus, (2) to improve medication appropriateness and health-related outcomes of the included residents.MethodsThe single-arm interventional study (2014–2017) was conducted in Muenster, Germany and involved healthcare professionals and residents of nursing homes.The intervention consisted of systematic education of participating healthcare professionals and of a structured interprofessional medication review which was performed via an online communication platform.The primary endpoint was assessed using the Medication Appropriateness Index MAI. Secondary endpoints were: cognitive performance, delirium, agitation, mobility, nu...
The PBAR Protocol: Antipsychotic Medication Reduction in the Nursing Home
2020
Neuropsychiatric symptoms (NPS) occur in almost all persons living with dementia. Antipsychotic medications are often prescribed inappropriately for persons living with dementia who experience NPS. Adverse side effects of antipsychotic medications include falls, sedation, cognitive dysfunction, prolonged QTc interval, extrapyramidal side effects, cerebrovascular events, metabolic changes, infection, and mortality. The purpose of this descriptive quality improvement project was to test the feasibility and preliminary effectiveness of using the Psychiatric Background Assessment Recommendation (PBAR) Interprofessional Communication Tool (ICT). The PBAR-ICT was adapted from the Situation Background Assessment Recommendation (SBAR) Protocol by the Principal Investigator and was used to report critical NPS in the nursing home. After approval from the university institutional review board, an education program on identifying NPS was provided to the nursing staff. The education program focu...
Journal of the American Medical Directors Association, 2022
Objectives:To summarize current evidence regarding facility and prescriber characteristics associated with potentially harmful medication (PHM) use by residents in nursing homes (NHs), which could inform the development of interventions to reduce this potentially harmful practice.Design:Scoping review.Setting and Participants:Studies conducted in the United States that described facility and prescriber factors associated with PHM use in NHs.Methods:Electronic searches of PubMed/MEDLINE were conducted for articles published in English between April 2011 and November 2021. PHMs were defined based on the Beers List criteria. Studies testing focused interventions targeting PHM prescribing or deprescribing were excluded. Studies were characterized by the strengths and weaknesses of the analytic approach and generalizability.Results:Systematic search yielded 1253 articles. Of these, 29 were assessed in full text and 20 met inclusion criteria. Sixteen examined antipsychotic medication (APM) use, 2 anticholinergic medications, 1 sedative-hypnotics, and 2 overall PHM use. APM use was most commonly associated with facilities with a higher proportion of male patients, younger patients, and patients with severe cognitive impairment, anxiety, depression, and aggressive behavior. The use of APM and anticholinergic medications was associated with low registered nurse staffing ratios and for-profit facility status. No studies evaluated prescriber characteristics.Conclusions and Implications:Included studies primarily examined APM use. The most commonly reported facility characteristics were consistent with previously reported indicators of poor NH quality and NHs with patient case mix more likely to use PHMs.
Implementation Science Communications, 2020
Background Antipsychotic medication use in nursing homes is associated with potential for harms. In Ontario, Canada, an agency of the provincial government offers nursing home physicians quarterly audit and feedback on their antipsychotic prescribing. We compared the characteristics of physicians who did and did not engage with the intervention, and assessed early changes in prescribing. Methods This population-level, retrospective cohort study used linked administrative databases to track prescribing practices in nursing homes pre-intervention (baseline), immediately post-initiative (3 months), and at follow-up (6 months). Exposure variables identified whether a physician signed up to participate (or not) or viewed the feedback following sign up (or not). Differences in the proportion of days that residents received antipsychotic medications at 6 months compared to baseline by exposure(s) were assessed using a linear mixed effects regression analysis to adjust for a range of reside...
Gerontology & Geriatric Medicine, 2015
Screening for Adverse Drug Events (ADEs) in nursing home setting is a crucial component of appropriate, quality care. This study examined potential differences in screening for ADEs by nurses and a physician-pharmacist consensus panel. A modified Harvard Medical Practice Study protocol was used in a two-stage screening process to identify ADEs in a retrospective chart review of 134 patients across four care facilities. The study nurse chart reviewers identified 17 of the 134 patients as having experienced an ADE. The total number of incidents identified among the 17 patients was 20. The two most frequent types of nurse identified ADEs were drug reactions (26.7%) and medication errors (10.0%). In contrast, the consensus panel reviewing the same nurse identified 17 patients identified a total of 69 ADE incidents. The largest discrepancy between the two screening groups was in the identification of adverse drug reactions (8 versus 46) and untreated conditions (none versus 7). The results underscore the need for further research examining how health care professionals use their clinical knowledge in identifying ADEs, and the development of protocols that address such possible professional differences.