Abstract
In nursing homes, antipsychotic prescribing decisions (APDs) for managing behavioral and psychological symptoms of dementia (BPSD) depend on the nursing staff’s feedback. Inappropriate APDs can result in the lack of timeliness, objectivity and important clinical information when nursing staff’s feedback on residents’ behavior and pharmacotherapy outcomes. Currently, there are no reported interventions for improving psychiatrists’ APDs through nursing staff’s monitoring and feedback processes. This one-group pre-and-post pilot study aimed to evaluate the feasibility and impact of implementing a newly-developed Psychotropic Use Monitoring (PUM) program for improving the appropriateness of APDs in a 50-bed dementia ward of a nursing home. The PUM intervention involved 16 pharmacist-trained nursing staff, who monitored and reported residents’ BPSD changes and psychotropic side effects for 24 weeks, while carrying out their routine care duties. A face-to-face interview was then administered to determine the nursing staff’s perceptions of PUM. Data of 51 residents were collected from hardcopy individual patient records to evaluate the changes in APDs and the number of resident falls before and after implementing PUM. The nursing staff reported increases in their knowledge, awareness, confidence, and actual frequency of monitoring for side effects, as well as their ability in differentiating and managing BPSD (p
Highlights
Behavioral and Psychological Symptoms of Dementia (BPSD) is present in up to 97% of persons with dementia over a five-year period [1], and often result in patient distress, caregiver stress, increased cost of care, nursing home admissions as well as a corresponding higher prevalence of antipsychotic use in the nursing homes compared to the social care setting [2]
Such inadequate monitoring and feedback processes contribute to inappropriate antipsychotic prescribing decisions (APDs), “over-prescribing” of antipsychotics without a clear indication or when they are no longer indicated, “mis-prescribing” of antipsychotics due to mis-identification of underlying target symptoms to be treated and “under-prescribing” of antipsychotics for residents who may benefit from short-term use of antipsychotics [13]
All 16 nursing staff involved in the Psychotropic Use Monitoring (PUM) program participated in the survey
Summary
Behavioral and Psychological Symptoms of Dementia (BPSD) is present in up to 97% of persons with dementia over a five-year period [1], and often result in patient distress, caregiver stress, increased cost of care, nursing home admissions as well as a corresponding higher prevalence of antipsychotic use in the nursing homes compared to the social care setting [2]. The lack of formal healthcare education among the NA and HA [9], inadequate monitoring processes in the nursing homes [10], caregiving stress due to low staff-to-resident ratio [6] and nurse-resident miscommunication due to cultural and language barriers [8] [11] may result in feedback that is delayed, subjective or lacking in important clinical information [12] Such inadequate monitoring and feedback processes contribute to inappropriate APDs, “over-prescribing” of antipsychotics without a clear indication or when they are no longer indicated, “mis-prescribing” of antipsychotics due to mis-identification of underlying target symptoms to be treated and “under-prescribing” of antipsychotics for residents who may benefit from short-term use of antipsychotics [13]
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