Psychotropic medications are commonly administered to elderly clients to manage behavior and psychiatric symptoms. These drugs are known to have potentially serious side effects, to which older adults are more vulnerable. Nurses care for older adults in many different practice settings but have varying degrees of knowledge about these kinds of medications. The purposes of this article are to (a) provide information to geriatric nurses in all settings about how the most commonly prescribed psychotropic medications (i.e., anxiolytic, antidepressant, and antipsychotic drugs) differentially affect older adults; (b) examine recent concerns about the use of psychotropic medications with older adults; and (c) discuss nursing implications for those administering psychotropic medications to older adults.
The findings demonstrate that clinical simulation is effective in improving students' knowledge and clinical judgment, specifically concerning rapid response systems.
Despite the known risks and the widespread administration of PRN (pro re nata or "as needed") psychotropic medications in inpatient settings, little is known about their use with hospitalized older adults. This exploratory descriptive study examined the use of PRN psychotropic medications and nonpharmacologic interventions to manage symptoms in older adults hospitalized in two acute care geropsychiatric settings. A retrospective chart audit was conducted. A major finding was the lack of documentation regarding PRN administration. In 81.3% of cases at Site A and 55.3% of cases at Site B, no reason for administration was documented. No medication response was documented in 92.4% of cases at Site A and 47.5% of cases at Site B. No nonpharmacologic interventions were documented for 69% of Site A patients or 64% of Site B patients. To ensure patient safety and to inform best clinical practice, the lack of documentation surrounding administration of PRN medications and nonpharmacologic interventions must be resolved.
The purposes of this article were to provide background information about rapid response teams (RRTs), to describe the actual and potential outcomes of RRTs, to define the potential role of the clinical nurse specialist in leading RRTs, and to provide recommendations for implementation of RRTs. Rapid response teams provide the opportunity for early intervention for patients demonstrating clinical decline before they reach a point of no return. The long-standing practice of waiting for intensive intervention (code blue) until the patient experiences cardiopulmonary arrest has shown poor outcomes, bringing this practice into question. Although research results are mixed, there is evidence to suggest that the successful use of RRTs results in clinically significant patient outcomes as evidenced by decreased cardiopulmonary arrests and decreased rates in mortality. Other positive patient, nursing, and organizational outcomes can result from RRTs and are discussed. Clinical nurse specialists are uniquely qualified to provide leadership in the development and implementation of RRTs and the monitoring of outcomes. As RRTs become a more common standard practice, further research is needed to examine their benefits and to further refine effective early intervention for high-risk patients.
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