Systematic Review of Psychotropic Adverse Drug Event Monitoring Tools for Use in Long-Term Care Facilities.

Abstract

To evaluate properties of psychotropic adverse drug event (ADE) monitoring tools intended for use in long-term care facilities. Systematic review. Adults aged 18years and older in nursing homes and other long-term care facilities. Medline, CINAHL, Embase, and PsycInfo were searched from inception to August 2022 for studies reporting the development, validation, or application of tools to monitor psychotropic ADEs. Screening, data extraction, and quality assessment were performed independently by 2 authors. Each tool was assessed under the domains of test-retest reliability, interrater reliability, content validity, and construct validity. Eight studies that described 6 tools were included. Tools were developed in Wales (n= 2), United States (n= 1), Ireland (n= 1), Canada (n= 1), and Singapore (n= 1). Tools monitored 4 to 95 items related to antipsychotics (n= 6 tools), antidepressants (n= 4), benzodiazepines or hypnotics (n= 4), antiepileptics (n= 4), and dementia medications (n= 1). Tools commonly monitored sedation, tiredness, or sleepiness (n= 6), falls (n= 4), and tremor or extrapyramidal symptoms (n= 4). Tools were designed for application by nurses (n= 4), during family conferences (n= 1), and by general medical practitioners before repeat prescribing (n= 1). Two tools were reported to require 10 to 60minutes to administer. Four tools were determined to have adequate content validity and 2 tools adequate interrater reliability. No tools reported test-retest reliability or construct validity. Six published psychotropic ADE monitoring tools are heterogeneous in design and intended application. Existing tools are predominately designed for application by nurses with or without direct involvement of the wider multidisciplinary team. Further research is needed into models of care that facilitate psychotropic ADE monitoring in the long-term care facility setting, and the extent to which application of specific tools is associated with reduced medication-related harm.