Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

Abstract

BackgroundPeople with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines’ monitoring.DesignPragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines’ monitoring versus usual care.SettingFive UK private sector care homesParticipants41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.InterventionNurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.OutcomesProblems addressed and changes in medicines prescribed.Data Collection and AnalysisInformation was collected from participants’ notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site.ResultsFive of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57–4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78–8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80–235.90] and 5.12 [1.45–18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15–17.22).ConclusionThe WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.Trial Registration ISRCTN 48133332

Testing an explanatory model of nurses’ intention to report adverse drug reactions in hospital settings

“…In fact, several recent studies have shown better quality and safer medication monitoring using the West Wales Adverse Drug Reaction Profile for patients with dementia in a nursing home (Jordan et al . ), and for patients with chronic respiratory disease in a nurse‐led respiratory outpatient clinic (Gabe et al . ).…”

“…, Jordan et al . ), and the implementation of dedicated nurses to monitor medication could be a bridge between the health care organisation and clinical nurses, stimulating the sharing of responsibility and the effective communication among team members.…”

Transformational leadership in nursing and medication safety education: a discussion paper

“…Safe medication management, transformational leadership and the Kolb learning cycle – an example based on the West Wales Adverse Drug Reaction Profile (Jordan et al ., ).…”

Clozapine deaths: monitoring adverse drug reactions

“…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.…”

“…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. Monitoring takes 10-20 minutes for each patient, including checks of vital signs, and causes no harm 25. Although it does take the time of frontline staff (nurses and carers), recording constipation, hypersalivation, behaviour change, weight gain, and other problems on a single sheet shared with prescribers and pharmacists can bring real benefits by preventing escalation.…”