Adverse drug events occur frequently in long-term care facilities, and nearly half of them are preventable

Frailty, dementia and complex multimorbidity are highly prevalent among residents of long-term care facilities (LTCFs). Prescribing for residents of LTCFs is often informed by disease-specific clinical practice guidelines based on research conducted among younger and more robust adults. However, frailty and cognitive impairment may modify medication benefits and risks. Residents with frailty and advanced dementia may be at increased susceptibility to adverse drug events (ADEs) and often have a lower likelihood of achieving long-term therapeutic benefit from chronic preventative medications. For this reason, there is a strong rationale for deprescribing, particularlyamong residents with high medication burdens, swallowing difficulties or limited dexterity. Conversely, frailty and dementia have also been associated with under-prescribing of clinically indicated medications. Unnecessarily withholding treatment based on assumed risk may deprive vulnerable population groups from receiving evidence-based care. There is a need for specific evidence regarding medication benefits and risks in LTCF residents with frailty and dementia. Observational studies conducted using routinely collected health data may complement evidence from randomized controlled trials that often exclude people living with dementia, frailty and in LTCFs. Balancing over- and under-prescribing requires consideration of each resident’s frailty and cognitive status, therapeutic goals, time-to-benefit, potential ADEs, and individual values or preferences. Incorporating frailty screening into medication review may also provide better alignment of medication regimens to changing goals of care. Timely identification of frail residents as part of treatment decision-making may assist with targeting interventions to minimize and monitor for ADEs. Shifting away from rigid application of conventional disease-specific clinical practice guidelines may provide an individualized and more holistic assessment of medication benefits and risks in the LTCF setting.

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The incidence of adverse drug events in two large academic long-term care facilities

The American Journal of Medicine ◽

10.1016/j.amjmed.2004.09.018 ◽

2005 ◽

Vol 118 (3) ◽

pp. 251-258 ◽

Cited By ~ 243

Author(s):

Jerry H. Gurwitz ◽

Terry S. Field ◽

James Judge ◽

Paula Rochon ◽

Leslie R. Harrold ◽

...

Keyword(s):

Long Term Care ◽

Adverse Drug Events ◽

Term Care ◽

Care Facilities

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PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review

Pharmacy ◽

10.3390/pharmacy7040157 ◽

2019 ◽

Vol 7 (4) ◽

pp. 157 ◽

Cited By ~ 3

Author(s):

Mojtaba Vaismoradi ◽

Flores Vizcaya Moreno ◽

Hege Sletvold ◽

Sue Jordan

Keyword(s):

Systematic Review ◽

Long Term Care ◽

Adverse Drug Events ◽

Psychotropic Medications ◽

Medicines Management ◽

Term Care ◽

Psychotropic Medicines ◽

Care Facilities ◽

Analysis And Synthesis

Many medications are prescribed and administered PRN (pro re nata, as needed). However, there are few integrative reviews to inform PRN psychotropic medication use in long-term care facilities and nursing or care homes. Accordingly, this integrative systematic review aimed to improve our understanding of PRN medicines management with a focus on psychotropic medications (antipsychotics, sedatives, anxiolytics, and hypnotics) in long-term care settings. Keywords relating to PRN in English, Norwegian, and Spanish were used, and articles published between 2009 and 2019 were retrieved. Based on the inclusion criteria, eight articles were used for data analysis and synthesis. This review offers a description of PRN prescription and administration of psychotropic medications in long-term care. Variations were observed in the management of PRN psychotropic medications based on residents’ underlying health conditions and needs, duration of use, and changes between medications and doses. Neither the reasons for PRN prescription and administration nor the steps taken to identify and manage any associated adverse reactions or adverse drug events were reported. Further initiatives are needed to improve PRN medicines management to explore factors that affect PRN prescription and administration and to develop appropriate PRN guidelines to prevent harm and improve the safety of people living in long-term care facilities.

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