Effect of an interdisciplinary educational program on antipsychotic prescribing among nursing home residents with dementia

Monette, Johanne; Champoux, Nathalie; Monette, M.; Fournier, Lynn; Wolfson, Christina; Fort, Guillaume Galbaud du; Sourial, Nadia; Cruguel, Jean-Pierre Le; Gore, Brian F.

doi:10.1002/gps.1934

Cited by 29 publications

(24 citation statements)

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“…The prevalence of antipsychotic use at the beginning of the program in Center A and Center B, 41.6% and 50.4%, respectively, was quite high compared to that observed in our pilot study (30.5%; Monette et al, 2008). Nonetheless, it reflects the increased trend in Canadian centers (Hagen, Armstrong-Esther, Ikuta et al, 2005;Rochon et al, 2007).…”

Section: Discussioncontrasting

confidence: 65%

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Effect of an Interdisciplinary Educational Program on Antipsychotic Prescribing Among Residents With Dementia in Two Long-Term Care Centers

Monette

Sourial

et al. 2012

J Appl Gerontol

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The effect of an educational program on antipsychotic prescribing was assessed in two Canadian long-term care centers (LTCC). In each center (Center A residents, n = 258 and Center B residents, n = 191, with dementia at program inception), the rate of change in the odds of using antipsychotics in residents was estimated using mixed-effects logistic regression during a 6-month program period and a 4-month postprogram period, with baseline proportions of use estimated during the 6 months prior to the program. Preprogram proportions of antipsychotic use were 41.6% and 46.2%, respectively. Antipsychotic use decreased during the program in both centers: (odds ratio with 95% CI: 0.943 per week [0.921, 0.965] and 0.969 per week [0.944, 0.994], respectively). During the postprogram period, antipsychotic use increased in Center A (1.039 per week [1.007, 1.072]) but decreased progressively in Center B. The study results suggest the need to implement an ongoing educational program in LTCC.

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Section: Discussioncontrasting

confidence: 65%

“…Our program, first tested in a pilot study in one center, led to a substantial reduction in the use of antipsychotics and in the frequency of behavioral disturbances (Monette et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Effect of an Interdisciplinary Educational Program on Antipsychotic Prescribing Among Residents With Dementia in Two Long-Term Care Centers

Monette

Sourial

et al. 2012

J Appl Gerontol

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“…En unité traditionnelle de maison de retraite, la présence d'un personnel formé semble réduire, et ce, indépendam-ment de son effectif, le taux de prescription de psychotropes [70,76,77]. Tous les travaux ne sont toutefois pas concordants [78].…”

Section: Formationunclassified

Unités spécifiques Alzheimer en EHPAD et prise en charge des troubles sévères du comportement: réflexion sur les critères de définition et missions

Villars

Gardette

Sourdet

et al. 2009

cah. année gerontol.

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“…cluded audits [14] [22] [23], medication reviews [21], education [15] [17] [20], multidisciplinary case-conferencing [19], early screening [16] and non-pharmacological management [18]. PUM is unique among these interventions as it emphasizes on the monitoring process, leveraging on the capabilities and roles of the pharmacist as the educator and advocator for appropriate medication use [33] and the nursing staff as the keen first-hand observer [34], to support the appropriate APDs by the visiting psychiatrist.…”

Section: Unique Characteristics Of the Pum Interventionmentioning

confidence: 99%

Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program

Yap¹,

Kua²,

Chan³

et al. 2014

OJPsych

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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 < 0.05). After PUM, there was a significant increase in the number of APDs due to side effect-related reasons (4 versus 16) (p < 0.031). Although not significant, the number of APDs with no documented reasons (5 versus 9) and the number of resident falls (7 versus 15) appeared to be lesser after PUM. This study demonstrated the nursing staff's positive participation in PUM inter-* Corresponding author. K. Z. Yap et al. 154vention, specifically in monitoring and feedback of side effects. Furthermore, a potential exists for PUM to encourage more judicious APDs, which may be useful in settings with heavy patient load, limited human resources and dependence on foreign nursing staff from differing cultural backgrounds.

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Effect of an interdisciplinary educational program on antipsychotic prescribing among nursing home residents with dementia

Cited by 29 publications

References 29 publications

Effect of an Interdisciplinary Educational Program on Antipsychotic Prescribing Among Residents With Dementia in Two Long-Term Care Centers

Effect of an Interdisciplinary Educational Program on Antipsychotic Prescribing Among Residents With Dementia in Two Long-Term Care Centers

Unités spécifiques Alzheimer en EHPAD et prise en charge des troubles sévères du comportement: réflexion sur les critères de définition et missions

Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program

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