Improving Medication Safety in Psychiatry - A Controlled Intervention Study of Nurse Involvement in Avoidance of Potentially Inappropriate Prescriptions.

Abstract

The aim of this controlled, before-and-after study in the Department of Psychiatry in a university hospital in Denmark was to examine the potential effects and characteristics of nurses reviewing psychiatric patients' medication records to identify potentially inappropriate prescriptions (PIPs). The control group and the intervention group each consisted of two bed units chosen based on patients' diagnoses and age categories. There were 396 patients (age ≥18 years) included in the study. Senior clinical pharmacology physicians performed medication reviews for all patients in the study; these medication reviews were considered gold standard. The intervention group: nurses were given a pharmacology course after which the nurses reviewed medication lists and subsequently conferred any identified PIPs with physicians. The control group: medication was reviewed as usual and nurses did not participate. Primary outcome measure was the potential difference in PIPs between the control group and the intervention group, analysed in two ways: (i) difference in mean number of PIPs and (ii) difference in number of patients exposed to ≥1 PIP, using regression analysis with an approximated difference-in-difference (DID) approach. Secondary outcome measure was characteristics of PIPs where physicians responded to nurse-identified PIPs. The DID between intervention group and control group for mean number of PIPs per patient was -0.23 (-1.07 to 0.60), and for number of patients receiving ≥1 PIP, the odds ratio was 0.61 (0.25 to 1.46). Physicians changed most prescriptions in the category interaction between drugs. Nurses could not significantly reduce the prevalence of PIPs for psychiatric patients.