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

People 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 clinica...

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Bibliographic Details
Published in:PloS one 2015-10, Vol.10 (10), p.e0140203-e0140203
Main Authors: Jordan, Susan, Gabe-Walters, Marie Ellenor, Watkins, Alan, Humphreys, Ioan, Newson, Louise, Snelgrove, Sherrill, Dennis, Michael S
Format: Article
Language:English
Subjects:
Aged
Analysis
Antidepressants
Complications and side effects
Costs
Data collection
Dementia
Dementia - drug therapy
Dementia - pathology
Demography
Drug Monitoring
Drug therapy
Female
Health sciences
Health services
Hospitals
Humans
Informatics
Intervention
Male
Medicine
Mental health
Nurses
Older people
Patient Care
Patient safety
Prescription Drugs - therapeutic use
Primary care
Psychotropic drugs
Systematic review
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Summary:People 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. Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care. Five UK private sector care homes. 41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine. Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step. Problems addressed and changes in medicines prescribed. Information 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. Five 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
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0140203