98 Scheduled Medication Reviews and Education on Sedative Prescribing for Responsive Behaviours in Nursing Home Residents, a 3 year Follow-Up Study

Abstract

Background Sedative medications including neuroleptics, benzodiazepines, opioids, ‘z’ drugs and trazadone are commonly prescribed for older adults. Nursing home residents are three times more likely to be prescribed benzodiazepines. Sedative medications are associated with significant risks including falls and delirium in older adults. Neuroleptics also increase risk of cerebrovascular disease and functional decline. Regular medication review and education have been shown to reduce rates of sedative use in nursing homes. Scheduled medication reviews were introduced in an Irish nursing home with a specific focus on reduction or discontinuation of these target medications in combination with education of management of Behavioural and Psychological symptoms (BPSD). We demonstrated previously a significant reduction in prescribing following these interventions. This audit examines the prescribing patterns 3 years on from the initial audit. Methods Point prevalence study of sedative prescriptions and BPSD on 6/5/21 of all 95 nursing home residents. Data compared with two preceding audits in 2018 in the same unit. All data anonymised. Data analysed with SPSS statistical software. Results Significant reduction in quetiapine use sustained from 30% of residents pre-intervention to 14% post-intervention in 2018 and 2021 (p = 0.06). Neuroleptic prescription reduced from 39% to 25% (p = 0.06). ‘Z’ drug prescribing increased from 8% to 17% (p = 0.03). 33% of residents had BPSD reported compared to 49% pre-intervention. Conclusion 3 year follow-up showed regularly scheduled medication reviews and education in a nursing home can effectively rationalise sedative prescription rates. Sustained reduction in neuroleptics and increased ‘z’ drug prescriptions may represent appropriate replacement. Reduced BPSD may be due to changing nursing home resident cohort or reporting bias of staff since the introduction of regular education.