Improving the appropriateness of psychotropic prescribing for nursing home residents with dementia: an overview of reviews

Wiggin, Daisy; Timmons, Suzanne; Rukundo, Aphie; Walsh, Kieran

doi:10.1080/13607863.2021.1922601

Cited by 12 publications

(6 citation statements)

References 48 publications

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“…Of the 2530 retrieved studies, 193 were ultimately included 6,7,11–201 . The PRISMA-ScR diagram (Figure 1) shows the study selection process and reasons for full-text exclusion.…”

Section: Resultsmentioning

confidence: 99%

Factors that influence the implementation of innovation in aged care: a scoping review

Windle,

Marshall,

de la Perrelle

et al. 2023

JBI Evidence Implementation

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Objective: The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care. Introduction: Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care. Inclusion criteria: This review included studies of any design, that examined the implementation of innovations in aged care settings. Methods: Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops. Results: Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies. Conclusions: Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.

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“…Of the 2530 retrieved studies, 193 were ultimately included 6,7,11–201 . The PRISMA-ScR diagram (Figure 1) shows the study selection process and reasons for full-text exclusion.…”

Section: Resultsmentioning

confidence: 99%

Factors that influence the implementation of innovation in aged care: a scoping review

Windle,

Marshall,

de la Perrelle

et al. 2023

JBI Evidence Implementation

View full text Add to dashboard Cite

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“…A recent review of reviews by our group synthesised the evidence for interventions, in residential care settings, to improve the appropriateness of psychotropic prescribing [ 38 ]. Education-only interventions and clinical protocols alone have uncertain evidence, while multicomponent interventions that include education, specialist outreach, audit and feedback, and psychosocial interventions for the residents have good evidence (with reported reductions in prescribing between 5 and 66% in one systematic review), as do medication review and efforts to improve the culture of the site [ 38 ]. Within acute hospitals, computerised interventions (electronic prescribing system alerts, clinical decision support, etc.)…”

Section: Discussionmentioning

confidence: 99%

Psychotropic Medication Prescribing to Patients with Dementia Admitted to Acute Hospitals in Ireland

et al. 2023

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Background Psychotropic medications are commonly prescribed to people with dementia (PwD) for non-cognitive symptoms of dementia (NCSD), but have significant risks. A national audit was performed in acute hospitals in the Republic of Ireland (ROI) to establish baseline practice prior to the launch and implementation of a National Clinical Guideline on the appropriate prescribing of psychotropic medications for NCSD. The objective of this study was to analyse psychotropic prescribing patterns and compare these with international data and with existing (limited) data from a previous audit round. Methods The pooled anonymous dataset from the second round of the Irish National Audit of Dementia Care (INAD-2) was analysed. The audit had collected retrospective data from 30 random healthcare records from each of 30 acute hospitals in 2019. Inclusion criteria were a clinical diagnosis of dementia of any type, hospital stay of 72 hours or more, and discharge or death within the audit period. Most hospitals (87%) self-audited their healthcare records, but a random sample of six healthcare records (20%) from each hospital were re-audited by a highly trained healthcare auditor. The audit tool was based on a tool used in the England and Wales National Audit of Dementia audit rounds (Royal College of Psychiatrists), adapted to the Irish healthcare setting and national priorities. Results In total, 893 cases were included, as one hospital could not retrieve 30 cases even within a more prolonged audit period. The sample comprised 55% females and 45% males; the median age was 84 years (interquartile range 79–88 years) and the majority (89.6%) were >75 years of age. Only 52% of healthcare records specified the type of dementia; within these, the most common diagnosis was Alzheimer’s disease (45%). Most PwD (83%) were receiving psychotropic medication on admission; 40% were prescribed new or increased psychotropic medication during admission, mainly for medical indications, including end-of-life care and delirium. Anticonvulsants or cognitive enhancers were rarely prescribed for NCSD in hospital. However, new/increased antipsychotic medication was prescribed for NCSD in 11.8–17.6% of the total cohort, while 4.5–7.7% were prescribed a benzodiazepine for anxiety or NCSD. Overall, there was poor documentation of risk/benefit, or of discussion with the patient/family, and apparently inadequate review for efficacy and tolerability. Concurrently, acetylcholinesterase inhibitors appeared to be underused for cognitive impairment in the community. Conclusion This audit provides baseline data on psychotropic medication prescription for NCSD in Irish hospitals prior to a specific Irish guideline on this topic. Reflecting this, most PwD were receiving psychotropic medications on admission, and many were prescribed new/increased psychotropic medication in hospital, often without evidence of appropriate decision making and prescribing proces...

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“…As stated before, stakeholders need to be trained, not only in implementing interventions but also on the topic of involuntary treatment, its negative consequences and lack of effectiveness. Two reviews have pointed out, however, that support of management and policy makers is needed to facilitate effective prevention and/or reduction of the use of involuntary treatment (Brugnolli et al, 2020; Wiggin et al, 2021). So, interprofessional education is needed in combination with the implementation of policies that have a goal of eradicating or restricting the use of involuntary treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the availability of (1) effective interventions mainly focused at the prevention and reduction of physical restraints (Brugnolli et al, 2020) and psychotropic medication (Wiggin et al, 2021), (2) rules and regulations that restrict the use of involuntary treatment (de Boer et al, 2019; Equality and Human Rights commision, 2019), and (3) policies of healthcare organisations that discourage the use of involuntary treatment (Mengelers, Bleijlevens, et al, 2020), its use remains common practice (de Boer et al, 2019; Gjerberg et al, 2013; Hamers et al, 2016; Moermans et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Professional caregivers' perceived barriers hindering the prevention and reduction of involuntary treatment among older persons receiving long‐term care: A mixed methods study

Willems

Passos

Hamers

et al. 2023

Journal of Clinical Nursing

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AimsTo gain insights into the barriers towards the prevention and/or reduction of involuntary treatment in long‐term geriatric care.DesignMixed methods.BackgroundMeasures to which a person resists and/or does not provide consent for are defined as involuntary treatment. The use of involuntary treatment violates the autonomy of (older) persons and causes more harm than benefit. Moreover, it contradicts the values of person‐centred care. Nevertheless, its use among people living with dementia (PLWD) is still common practice.MethodsWe conducted a cross‐sectional, mixed methods study, including an online survey for professional caregivers and a semistructured focus group interview with professional caregivers.ResultsA total of 218 participants completed the questionnaire. The percentage of participants who perceived barriers in one of the 22 survey items ranged from 15% to 42%. Lack of time, the experienced need to use involuntary treatment, uncertainty about responsibilities of stakeholders and a lack of knowledge on methods to prevent and/or reduce the use of involuntary treatment were most seen as barriers. Nursing staff perceived a lack of time hindering them in the prevention or reduction of involuntary treatment more often than other professional caregivers. Working in home care and having no former experience with involuntary treatment usage increased perceived barriers. Participants of the focus group interview confirmed these findings and added that professional caregivers in general lack awareness on the concept of involuntary treatment.ConclusionsOne out of four professional caregivers experiences barriers hindering prevention and/or reduction of involuntary treatment. More research is needed to gain a better understanding of how professional caregivers can be supported to remove barriers and, consequently, prevent and/or reduce the use of involuntary treatment.Relevance to Clinical PracticeProfessional caregivers experience many barriers towards the prevention and reduction of involuntary treatment. Future initiatives should aim to remove the perceived barriers.

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Improving the appropriateness of psychotropic prescribing for nursing home residents with dementia: an overview of reviews

Cited by 12 publications

References 48 publications

Factors that influence the implementation of innovation in aged care: a scoping review

Factors that influence the implementation of innovation in aged care: a scoping review

Psychotropic Medication Prescribing to Patients with Dementia Admitted to Acute Hospitals in Ireland

Professional caregivers' perceived barriers hindering the prevention and reduction of involuntary treatment among older persons receiving long‐term care: A mixed methods study

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