A pharmacist-led pilot using a performance dashboard to improve psychotropic medication use in a skilled nursing facility

• Published in: BMJ open quality 2020-08, Vol.9 (3), p.e000997
• Main Authors: Bell, Kristin, Hartmann, Christine, Baughman, Amy Wisteria
• Format: Article
• Language: English
• Subjects: Anesthesia; clinical pharmacology; Dementia; Drug stores; geriatrics; Health administration; Histamine; information technology; Intervention; Long term health care; long-term care; Medical records; Mortality; Nursing; Older people; Original Research; Patients; Pharmacists; Polypharmacy; Product safety; Psychotropic drugs; Quality control; Quality improvement; Quality of care; Trends; Veterans
• ISSN: 2399-6641; 2399-6641
• DOI: 10.1136/bmjoq-2020-000997

ObjectivesInappropriate use of psychotropic medications in the elderly, particularly those with dementia, is a critical safety and quality concern. This pilot quality improvement study used a novel Department of Veterans Affairs (VA) Psychotropic Drug Safety Initiative performance dashboard (PDSI dashboard) to implement a pharmacist-led intervention to improve psychotropic medication prescribing practices in a VA skilled nursing facility (SNF). While clinical dashboard data have become commonplace, literature describing successful implementation for improved clinical care is scant.MethodsThis study took place from November 2015 to February 2016 at a 112-bed VA SNF. A pharmacist used the PDSI dashboard to identify ‘actionable’ patients with potentially inappropriate psychotropic prescribing and then completed chart reviews to confirm clinical indications. The pharmacist provided recommendations to providers for dose reductions or deprescribing via in-person communication and notes written in the electronic medical record. SNF providers completed anonymous surveys about their experience in receiving recommendations.ResultsOver a 5-month period, the PDSI dashboard identified 21 patients with potentially inappropriate psychotropic medication use, with approximately one new patient identified each week. Prescribing recommendations were accepted 66% of the time. All seven SNF providers reported that recommendations were helpful in improving their psychotropic prescribing practices.ConclusionsThe PDSI dashboard was efficient and effective in identifying patients at risk for inappropriate use of psychotropic medications. A clinical pharmacist was essential for implementing and communicating recommendations from the dashboard to providers.