Nurse-led medicines’ monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement initiative for mental health medicines: An observational and interview study
Autoři:
Sue Jordan aff001; Timothy Banner aff001; Marie Gabe-Walters aff003; Jane M. Mikhail aff001; Gerwyn Panes aff001; Jeff Round aff004; Sherrill Snelgrove aff001; Mel Storey aff001; David Hughes aff001;
Působiště autorů:
College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
aff001; Cardiff and Vale University Health Board, Wales, United Kingdom
aff002; Swansea Bay University Health Board, Wales, United Kingdom
aff003; Institute of Health Economics, Edmonton, Alberta, Canada
aff004; Hywel Dda University Health Board, Wales, United Kingdom
aff005
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0220885
Souhrn
Introduction
Preventable adverse effects of medicines often pass unnoticed, but lead to real harm.
Intervention
Nurse-led monitoring using the structured Adverse Drug Reaction (ADRe) Profile identifies and addresses adverse effects of mental health medicines.
Objectives
This study investigated the implementation and clinical impact of ADRe, and barriers to and facilitators of sustained utilisation in routine practice.
Methods
Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales.
Results
Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [1–2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation.
Implications
To our knowledge, ADRe is the only instrument that brings a full account of patients’ problems to medication reviews. This juxtaposition of signs and symptoms against prescriptions facilitates dose adjustments and de-prescribing and leads to: reduced pain and sedation; early identification of problems linked to ADRs, such as falls; and timely medication reviews e.g. for dyspnoea.
Klíčová slova:
People and places – Population groupings – Professions – Medicine and health sciences – Health care – Health care providers – Medical doctors – Nurses – Medical personnel – Pharmacology – Neurology – Drugs – Mental health and psychiatry – Pharmacists – Antipsychotics – Adverse reactions – Sleep disorders – Dyssomnias – Insomnia
Zdroje
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