Minimizing side‐effects: the clinical impact of nurse‐administered ‘side‐effect’ checklists

Jordan, Sue; Tunnicliffe, Carol; Sykes, Alan M.

doi:10.1046/j.1365-2648.2002.02064.x

Cited by 43 publications

(61 citation statements)

References 53 publications

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“…The Profile prompted health promotion regarding sub-optimal health behaviours, such as poor mouth care or adding salt to meals, and referrals to other professionals. Although some problems were addressed immediately, such as changes in doses of respiratory medicines, clinical gains from nurse-led medication monitoring in outpatient departments depend, in part, on participants following advice to contact other healthcare professionals [60], [61]: for example to treat suspected infections (12/26), obtain overdue vaccinations (12/26) or investigate falls (2/26). Instigation of further treatment or over-treatment would be at the discretion of professionals receiving the referrals, and not directly attributable to the Profile.…”

Section: Discussionmentioning

confidence: 99%

“…Patient safety might be improved by concurrent medication monitoring using drug specific checklists [61], [80], [102]–[106]. The WWADR Profile helped nurses structure and prioritise care, and identify previously unsuspected problems.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, 14/20 patients receiving usual care and 1/20 patients responding to a structured monitoring instrument had no ADRs on a monitoring profile addressed by their nurses [60], [61]. A sample of 34, 17 in each arm, is sufficient to detect this difference in incidence of nursing actions with 90% power when using 1% significance level [62].…”

Section: Methodsmentioning

confidence: 99%

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Medication Monitoring in a Nurse-Led Respiratory Outpatient Clinic: Pragmatic Randomised Trial of the West Wales Adverse Drug Reaction Profile

et al. 2014

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ObjectiveTo assess the clinical effect of medication monitoring using the West Wales Adverse Drug Reaction (ADR) Profile for Respiratory Medicine.DesignSingle-site parallel-arm pragmatic trial using stratified randomisation.SettingNurse-led respiratory outpatient clinic in general hospital in South Wales.Participants54 patients with chronic respiratory disease receiving bronchodilators, corticosteroids or leukotriene receptor antagonists.InterventionFollowing initial observation of usual nursing care, we allocated participants at random to receive at follow up: either the West Wales ADR Profile for Respiratory Medicine in addition to usual care (‘intervention arm’ with 26 participants); or usual care alone (‘control arm’ with 28 participants).Main Outcome MeasuresProblems reported and actions taken.ResultsWe followed up all randomised participants, and analysed data in accordance with treatment allocated. The increase in numbers of problems per participant identified at follow up was significantly higher in the intervention arm, where the median increase was 20.5 [inter-quartile range (IQR) 13–26], while that in the control arm was −1 [−3 to +2] [Mann-Whitney U test: z = 6.28, p<0.001]. The increase in numbers of actions per participant taken at follow up was also significantly higher in the intervention arm, where the median increase was 2.5 [1]–[4] while that in the control arm was 0 [−1.75 to +1] [Mann-Whitney U test: z = 4.40, p<0.001].ConclusionWhen added to usual nursing care, the West Wales ADR Profile identified more problems and prompted more nursing actions. Our ADR Profile warrants further investigation as a strategy to optimise medication management.Trial RegistrationControlled-trials.com ISRCTN10386209

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Medication Monitoring in a Nurse-Led Respiratory Outpatient Clinic: Pragmatic Randomised Trial of the West Wales Adverse Drug Reaction Profile

et al. 2014

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“…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. While the use of the validated APP scale in the PUM form ensured the objectivity and clinical relevance of the nursing staff's monitoring and feedback, the observation-based PUM intervention enabled the nursing staff to monitor residents efficiently and overcome potential language barriers between the majority of non-English-speaking residents and nursing staff (or English-speaking residents and non-English-speaking nursing staff) when assessing BPSD changes and side effects.…”

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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“…In acute mental healthcare234 and other settings,5 we have shown that the introduction of thorough, structured checks by nurses and care staff can identify problems related to antipsychotics and prompt preventive action. We developed an intervention 67 to facilitate nurse led review of patients with serious mental illness, which pre-empted serious adverse reactions, including chest pain and pancreatitis 2.…”

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confidence: 99%

Clozapine deaths: monitoring adverse drug reactions

Jordan

Hughes

2019

BMJ

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Minimizing side‐effects: the clinical impact of nurse‐administered ‘side‐effect’ checklists

Cited by 43 publications

References 53 publications

Medication Monitoring in a Nurse-Led Respiratory Outpatient Clinic: Pragmatic Randomised Trial of the West Wales Adverse Drug Reaction Profile

Medication Monitoring in a Nurse-Led Respiratory Outpatient Clinic: Pragmatic Randomised Trial of the West Wales Adverse Drug Reaction Profile

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

Clozapine deaths: monitoring adverse drug reactions

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