Examining Trends in the Administration of “As Needed” Medications to Inpatients With Behavioral and Psychological Symptoms of Dementia

Neumann, Robert D.; Faris, Peter; Klassen, Richard

doi:10.1177/1533317515585924

Cited by 9 publications

(14 citation statements)

References 24 publications

(36 reference statements)

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“…Consistent with previous literature,28 and presumably reflective of both staffing levels and the inherent nature of behavior disturbance associated with delirium and dementia, referrals to the ART team frequently occur outside of normal working hours. This is another pointer to prevention and management.…”

Section: Discussionsupporting

confidence: 75%

Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

Simpkins¹,

Peisah²,

Boyatzis³

2016

CIA

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AimThe management of severely agitated elderly patients is not easy, and limited guidelines are available to assist practitioners. At a Sydney hospital, an Aggression Response Team (ART) comprising clinical and security staff can be alerted when a staff member has safety concerns. Our aims were to describe the patient population referred for ART calls, reasons for and interventions during ART calls, and complications following them.MethodsPatients 65 years and older referred for ART calls in the emergency department or wards during 2014 were identified using the Incident Information Management System database and medical records were reviewed. Demographic and clinical data were collected.ResultsOf 43 elderly patients with ART calls, 30 had repeat ART calls. Thirty-one patients (72%) had underlying dementia, and 22 (51%) were agitated at the time of admission. The main reasons for ART calls were wandering and physical aggression. Pharmacological sedation was used in 88% of the ART calls, with a range of psychotropics, doses, and routes of administration, including intravenous (19%) and, most commonly, midazolam (53%). Complications were documented in 14% of cases where sedation was used.ConclusionWe observed a high frequency of pharmacological sedation among the severely agitated elderly, with significant variance in the choice and dose of sedation and a high rate of complications arising from sedation, which may be an underestimate given the lack of post-sedation monitoring. We recommend the development of guidelines on the management of behavioral emergency in the elderly patients, including de-escalation strategies and standardized psychotropic guidelines.

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Section: Discussionsupporting

confidence: 75%

Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

Simpkins¹,

Peisah²,

Boyatzis³

2016

CIA

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“…Eighteen studies were excluded [ 16 , 21 , 23 , 24 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. Details of the excluded studies are in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Patient Safety and Pro Re Nata Prescription and Administration: A Systematic Review

2018

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PRN is the acronym for ‘pro re nata,’ written against prescriptions whose administration should be based on patients’ needs, rather than at set times. The aim of this systematic review was to explore safety issues and adverse events arising from PRN prescription and administration. Electronic databases including Scopus, PubMed [including Medline], Embase, Cinahl, Web of Science and ProQuest were systematically searched to retrieve articles published from 2005 to 2017. Selection criteria: we included all randomized controlled trials (RCTs) and studies with comparison groups, comparing PRN prescription and administration with scheduled administration, where safety issues and adverse events were reported. The authors independently assessed titles, abstracts and full-texts of retrieved studies based on inclusion criteria and risk of bias. Results were summarised narratively. The search identified 7699 articles. Title, abstract and full-text appraisals yielded 5 articles. The included studies were RCTs with one exception, a pre-test post-test experimental design. Patient populations, interventions and outcomes varied. Studies compared patient-controlled or routine administration with PRN and one trial assessed the effect of a practice guideline on implementation of PRN administration. More analgesia was administered in the patient-controlled than the PRN arms but pain reduction was similar. However, there was little difference in administration of psychotropic medicines. No differences between patient-controlled and PRN groups were reported for adverse events. The PRN practice guideline improved PRN patient education but non-documentation of PRN administration increased. This systematic review suggests that PRN safety issues and adverse events are an under-researched area of healthcare practice. Variations in the interventions, outcomes and clinical areas make it difficult to judge the overall quality of the evidence. Well-designed RCTs are needed to identify any safety issues and adverse events associated with PRN administration.

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“…PRN medications are often ordered with a dose range and more than one route (e.g. oral, intramuscular [IM]), enabling nurses to determine the dosage, route, and the time of administration (Harper et al, 2017; Neumann et al, 2015). Therefore, the decision to administer a PRN is at the individual nurse's discretion (Hynninen et al, 2014; Neumann et al, 2015).…”

Section: Prn Administration Of Psychotropic Medicationsmentioning

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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Examining Trends in the Administration of “As Needed” Medications to Inpatients With Behavioral and Psychological Symptoms of Dementia

Cited by 9 publications

References 24 publications

Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

Patient Safety and Pro Re Nata Prescription and Administration: A Systematic Review

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

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