Exploring the link between organizational climate and the use of psychotropic medicines in nursing homes: A qualitative study

Sawan, Mouna; Jeon, Yun‐Hee; Fois, Romano A.; Chen, Timothy

doi:10.1016/j.sapharm.2016.06.012

Cited by 46 publications

(70 citation statements)

References 36 publications

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“…Nursing staff, especially those who are inexperienced or time‐poor, may find it difficult to implement nonpharmacological approaches to manage BPSD and are subsequently vulnerable to overreliance on psychotropic medications . Organisational factors such as inadequate staffing, managerial expectations, and teamwork between staff and visiting health professionals can contribute to a “prescribing culture” within a facility . This is exacerbated where GPs lack confidence and skills to recommend nonpharmacological approaches to manage BPSD .…”

Section: Discussionmentioning

confidence: 99%

Why deprescribing antipsychotics in older people with dementia in long‐term care is not always successful: Insights from the HALT study

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Harrison

et al. 2019

Int J Geriat Psychiatry

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Introduction Antipsychotic medications are commonly used to manage behavioural and psychological symptoms of dementia despite their side effects and harms. While the Halting Antipsychotic Use in Long‐Term care (HALT) deprescribing trial was successful at reducing antipsychotic use, 19% of participants had their antipsychotics represcribed or never reached a dose of zero. The aim of this study was to investigate the reasons for represcription of antipsychotic medication and factors associated with ongoing antipsychotic use, relating to care staff requests and perceived behavioural changes. Materials and methods Thirty‐nine of 133 HALT participants never ceased their antipsychotic medication or were represcribed a regular or pro re nata (PRN) antipsychotic after initial deprescribing. The views of nursing staff, general practitioner, and family on the circumstances leading up to these outcomes were collected via a questionnaire‐based approach. This information was triangulated with observation and detailed file audit (including progress notes, medical notes, medication charts, incident reports, and hospital discharge summaries). A consensus panel reconstructed the represcribing context. Results Nurses were the most common drivers of represcribing (63.2%), followed by family members (39.5%), GPs (23.7%), specialists (13.2%), and hospital staff (10.5%). There were multiple drivers for antipsychotic use in 46.2% of participants. Increased agitated and aggressive behaviours were the most commonly reported reasons for represcribing even though these changes were not identified over time on objective measures. Consent and dosage practices remained poor despite education. Discussion Nursing staff are the key drivers of deprescribing particularly in response to perceived worsening agitation and aggression among male residents. The train‐the‐trainer model used in the HALT trial may have been insufficient on its own to improve staff competence and confidence in applying nonpharmacological approaches when responding to behaviour change.

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Section: Discussionmentioning

confidence: 99%

Why deprescribing antipsychotics in older people with dementia in long‐term care is not always successful: Insights from the HALT study

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Harrison

et al. 2019

Int J Geriat Psychiatry

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“…The association between caring behaviours and organisational culture was strong and merits further attention . Caring behaviours have been reportedly associated with quality of worklife of those providing the care .…”

Section: Discussionmentioning

confidence: 91%

The caring behaviours of Danish pharmaconomists: insight for pharmacy technician practice around the world

Desselle

Hoh

Rossing

et al. 2018

International Journal of Pharmacy Practice

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“…Participants reported that resident pharmaceutical goals and preferences were not shared between staff and health‐care practitioners due to communication gaps created by lack of access to documentation and reduction in face‐to‐face communication. These barriers influence teamwork among staff and health‐care professional overall and can lead to inappropriate prescribing . Staff found that the use of a CCDSS would improve communication and teamwork among staff and other health‐care professionals and can be integrated in the medication management care plan at the time of admission to document resident pharmaceutical goals that are accessible to all members.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of residential aged care facilities' staff on the identification and recording of residents' medication‐related goals of care

2019

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Objective This study primarily aims to explore residential aged care facility (RACF) staff views on the utility of a computerised clinical decision support system (CCDSS) that incorporates validated goal‐directed deprescribing tools and guides to identify residents' goals for medications. Methods A qualitative study was conducted in four RACFs. Semi‐structured interviews or focus groups were conducted with 19 participants, representing various types of clinical and care staff. Results According to staff, the use of a CCDSS was useful as it facilitated resident (including people with dementia), and caregiver engagement to obtain comprehensive information about the residents' goals and medication concerns. Staff perceptions of the increased workload and that some residents and caregivers would have limited involvement in discussions were barriers to the adoption of a CCDSS. Conclusion Integration of a CCDSS into practice, accompanied with staff training and education, has the potential to improve goal‐directed pharmaceutical care.

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Exploring the link between organizational climate and the use of psychotropic medicines in nursing homes: A qualitative study

Cited by 46 publications

References 36 publications

Why deprescribing antipsychotics in older people with dementia in long‐term care is not always successful: Insights from the HALT study

Why deprescribing antipsychotics in older people with dementia in long‐term care is not always successful: Insights from the HALT study

The caring behaviours of Danish pharmaconomists: insight for pharmacy technician practice around the world

Perspectives of residential aged care facilities' staff on the identification and recording of residents' medication‐related goals of care

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