Determinants of the nurses’ and nursing assistants’ request for antipsychotics for people with dementia

Janus, Sarah I M; Manen, Jeannette G. van; IJzerman, Maarten Joost; Bisseling, Marloes; Drossaert, Constance H.C.; Zuidema, Sytse U.

doi:10.1017/s1041610216001897

Cited by 20 publications

(21 citation statements)

References 28 publications

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“…Furthermore, staff have often been found to be inadequately trained in person-centered care. 46,47,49 Our findings suggest that inadequate skills and knowledge are enabling inappropriate antipsychotic prescribing. Even in highly capable individuals, we found a tension between doing the 'right thing' and doing what's practical, given resource limitations and their duty of care to other residents.…”

Section: Comparison With Previous Researchmentioning

confidence: 74%

Influences on Decision-Making Regarding Antipsychotic Prescribing in Nursing Home Residents With Dementia: A Systematic Review and Synthesis of Qualitative Evidence

Walsh

Dennehy

Sinnott

et al. 2017

Journal of the American Medical Directors Association

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Antipsychotic prescribing in nursing home residents with dementia occurs in a complex environment involving the interplay of various stakeholders, the nursing home organization, and external influences. To improve the quality of antipsychotic prescribing in this cohort, a more holistic approach to BPSD management is required. Although we have found the issue of antipsychotic prescribing has been extensively explored using qualitative methods, there remains a need for research focusing on how best to change the prescribing behaviors identified.

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Section: Comparison With Previous Researchmentioning

confidence: 74%

Influences on Decision-Making Regarding Antipsychotic Prescribing in Nursing Home Residents With Dementia: A Systematic Review and Synthesis of Qualitative Evidence

Walsh

Dennehy

Sinnott

et al. 2017

Journal of the American Medical Directors Association

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“…The term responsive behaviours are used to signal that the behaviour is communication about an unmet need. However, studies suggest that nurses often opt for pharmacologic interventions over non‐pharmacological interventions (Haw & Wolstencroft, 2014; Janus et al, 2017; Lindsey & Buckwalter, 2012). It is not clear pharmacological interventions are chosen due to lack of knowledge about non‐pharmacological interventions, or if there may be other reasons nurses opt for pharmacological interventions.…”

Section: Introductionmentioning

confidence: 99%

Nurses’ decision‐making related to administering as needed psychotropic medication to persons with dementia: an empty systematic review

Walsh

Dahlke

OʼRourke

et al. 2021

Int J Older People Nursing

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Behavioural and psychological symptoms of dementia occur in approximately 75% of people with dementia admitted to acute care. Acute care nurses’ decision‐making regarding administering ‘as needed’ (pro re nata or PRN) psychotropic medications to persons with dementia are not well understood. This is an important clinical concern because ‘as needed’ medications are given at the discretion of the nurse. A comprehensive, systematic search and screen for studies that explored nurses’ decision‐making related to administering as needed psychotropic medication to persons with dementia in acute care settings was conducted. No studies that reported nurses’ decision‐making related to administration of as needed psychotropic medications to hospitalized persons with dementia were identified. In light of this, we present a discussion based on a narrative review of what is known on this topic from other settings, based on papers found in our original review. We will briefly explore what is needed in future research to address the gap in knowledge about nurse’ decision‐making related to administering as needed psychotropic medications.Implications for practiceResearch is needed to understand and inform the decision‐making process in the administration of as needed psychotropic medications to hospitalized persons with dementia.

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“…In people with dementia, antidepressants are not very effective at treating depression [6], and atypical antipsychotics have a negligible effect on agitation and psychosis [7]. Non-patient related factors can also influence PTD prescriptions, such as staff-patient ratio and staff distress related to patients' symptoms [8,9], the knowledge gap among NH personnel about the related adverse effects of medication [10], communication education [11], and health care personnel's positive belief or confidence in prescribing or discontinuing medication [12,13]. Moreover, it can be challenging to monitor a drug therapy, as different screening tools for inappropriate prescribing may recommend different pharmacological measures [14].…”

Section: Introductionmentioning

confidence: 99%

Do prescription rates of psychotropic drugs change over three years from nursing home admission?

et al. 2021

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Background In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription. Methods We used data from the Resource Use and Disease Course in Dementia – Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period. Results PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%–42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92–0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85–0.94, p < 0.001). Conclusions PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs. Trial registration ClinicalTrials.gov Identifier: NCT01920100.

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Determinants of the nurses’ and nursing assistants’ request for antipsychotics for people with dementia

Abstract: Policy-makers should focus on the nurses' and nursing assistants' belief in positive effects of antipsychotics for the resident, which is not in line with available evidence. Nurses and nursing assistants should be educated about the limited effectiveness of antipsychotics.

Cited by 20 publications

References 28 publications

Influences on Decision-Making Regarding Antipsychotic Prescribing in Nursing Home Residents With Dementia: A Systematic Review and Synthesis of Qualitative Evidence

Influences on Decision-Making Regarding Antipsychotic Prescribing in Nursing Home Residents With Dementia: A Systematic Review and Synthesis of Qualitative Evidence

Nurses’ decision‐making related to administering as needed psychotropic medication to persons with dementia: an empty systematic review

Do prescription rates of psychotropic drugs change over three years from nursing home admission?

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