scholarly journals Pro Re Nata Use of Psychotropic Medications in Assisted Living

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 706-706
Author(s):  
Paula Carder ◽  
Sheryl Zimmerman ◽  
Christopher Wretman ◽  
Sarah Dys ◽  
Philip Sloane
Keyword(s):  
Psychotropic Medication ◽  
Assisted Living ◽  
Medication Administration ◽  
Psychotropic Medications ◽  
Data Sources ◽  
Regulatory Requirements ◽  
Dementia Diagnosis ◽  
Pro Re Nata ◽  
Hospice Use ◽  
Record Review

Abstract This study examined the use of pro re nata (PRN, or as needed) psychotropic medications among assisted living (AL) residents. We examined prescriptions and administrations, and compared use based on dementia diagnosis. Data sources included interviews with administrators of 250 AL communities in 7 states and medication administration record review for the prior 7 days; analyses were weighted to the entire state. The percent of all residents prescribed a PRN psychotropic medication was 10.3%. However, residents with a dementia diagnosis were twice as likely to have a PRN psychotropic prescription (15.2% versus 7.2%; p<.001). The majority of psychotropic medications prescribed and administered were for anxiolytics/hypnotics rather than antipsychotics. Additional resident-level factors significantly associated with higher PRN prescribing included psychiatric diagnosis, incontinence, hospice use, confusion/disorientation, and agitation. We summarize these and other findings in the context of state regulatory requirements for staffing, chemical restraints, and dementia care.

Direct care staff knowledge about medication for individuals with intellectual disabilities

2019 ◽  
Vol 13 (3/4) ◽  
pp. 144-151
Author(s):  
Amanda Sawyer ◽  
Johanna Lake ◽  
Yona Lunsky
Keyword(s):  
Intellectual Disabilities ◽  
Psychotropic Medication ◽  
Medication Use ◽  
Medication Administration ◽  
Psychotropic Medications ◽  
Direct Care ◽  
Care Staff ◽  
Direct Care Staff ◽  
Content Type ◽  
Adults With Intellectual Disabilities

Purpose The majority of adults with intellectual disabilities (ID) are prescribed at least one, if not multiple medications, with psychotropic medications being the most commonly prescribed. Direct care staff play an important role in psychotropic medication administration and monitoring, yet little is known about their knowledge and comfort with medication. The paper aims to discuss this issue. Design/methodology/approach A 15-item survey, focusing on self-reported knowledge and comfort with psychotropic medication, was completed by 152 direct care staff employed at three agencies providing residential services for individuals with ID across Ontario. Findings In total, 62 per cent of staff respondents reported that psychotropic medications were among the top medications regularly taken by the individuals they support, with behaviour listed as the most commonly reported reason for taking this medication. The majority of staff reported monitoring medication, however, the frequency of monitoring varied considerably. Generally, staff reported feeling comfortable and knowledgeable about medication use, but, most reported a desire for additional medication training. Originality/value This is the first Canadian study to examine staff knowledge and comfort regarding medication use, and the first study to assess PRN (“as needed”) as well as regularly administered medications.

Pro Re Nata Prescribing and Administration of Psychotropic Medications in Assisted Living: A 7-State Study

2021 ◽  
Author(s):  
Paula Carder ◽  
Sheryl Zimmerman ◽  
Christopher J. Wretman ◽  
John S. Preisser ◽  
Sarah Dys ◽  
...  
Keyword(s):  
Assisted Living ◽  
Psychotropic Medications ◽  
State Study ◽  
Pro Re Nata

scholarly journals Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-centre study

2020 ◽  
Vol 11 (6) ◽  
pp. 1043-1050
Author(s):  
Madeline A. D. Izza ◽  
Eleanor Lunt ◽  
Adam L. Gordon ◽  
John R. F. Gladman ◽  
Sarah Armstrong ◽  
...  
Keyword(s):  
Psychotropic Medication ◽  
Psychological Symptoms ◽  
Care Home ◽  
Medication Administration ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Multi Centre Study ◽  
Falls Risk ◽  
Logistic Regression Models ◽  
Risk Of Falls

Abstract Purpose Falls and polypharmacy are both common in care home residents. Deprescribing of medications in residents with increased falls risk is encouraged. Psychotropic medications are known to increase falls risk in older adults. These drugs are often used in care home residents for depression, anxiety, and behavioural and psychological symptoms of dementia. However, a few studies have explored the link between polypharmacy, psychotropic medications, and falls risk in care home residents. Methods This was a prospective cohort study of residents from 84 UK care homes. Data were collected from residents’ care records and medication administration records. Age, diagnoses, gender, number of medications, and number of psychotropic medications were collected at baseline and residents were monitored over three months for occurrence of falls. Logistic regression models were used to assess the effect of multiple medications and psychotropic medication on falls whilst adjusting for confounders. Results Of the 1655 participants, mean age 85 (SD 8.9) years, 67.9% female, 519 (31%) fell in 3 months. Both the total number of regular drugs prescribed and taking ≥ 1 regular psychotropic medication were independent risk factors for falling (adjusted odds ratio (OR) 1.06 (95% CI 1.03–1.09, p < 0.01) and 1.39 (95% CI 1.10–1.76, p < 0.01), respectively). The risk of falls was higher in those taking antidepressants (p < 0.01) and benzodiazepines (p < 0.01) but not antipsychotics (p > 0.05). Conclusion In UK care homes, number of medications and psychotropic medications (particularly antidepressants and benzodiazepines) predicted falls. This information can be used to inform prescribing and deprescribing decisions.

scholarly journals Implementing an Interdisciplinary Committee to Reduce Psychotropic Drug and Increase Behavioral Intervention Use

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 306-306
Author(s):  
Lauren Hess Conrad ◽  
David Portman
Keyword(s):  
Psychotropic Drug ◽  
Behavioral Intervention ◽  
Psychotropic Medication ◽  
Behavioral Interventions ◽  
Psychotropic Medications ◽  
Interdisciplinary Treatment ◽  
Fiscal Year ◽  
Term Care ◽  
Care Plans ◽  
And Behavior

Abstract In Fiscal Year (FY) 2018, the Butler VA Health Care System’s Psychotropic Medication and Behavior Management Committee was identified as a Veterans Integrated Service Network 4 Best Practice. The goal of this committee is to reduce unnecessary psychotropic medication use and polypharmacy and to increase behavioral intervention implementation among Community Living Center (CLC) Veterans. This committee meets quarterly to review Psychotropic Drug Safety Initiative data, behaviors and behavior care plans, and all psychotropic medications prescribed to Veterans. Psychiatric diagnoses, changes to psychotropic medications, and appropriate behavioral interventions are discussed. Committee members take responsibility for action items in accordance with their discipline; documentation of recommendations are made in quarterly behavioral health assessments in CPRS; and follow-up on action items is completed at twice weekly interdisciplinary treatment team meetings, weekly behavior rounds, and/or as needed. From the first quarter (Q1) of FY16 to Q1 FY20, the Butler VA CLC has seen decreased prescriptions of 2 or more anticholinergics (6.6% to 0.80%), antihistamines (12.5% to 5.9%), benzodiazepines (24.7% to 11.0%), and benzodiazepines or sedative hypnotics (23.2% to 9.0%). While prescription of antipsychotic use has increased (Q1 FY20 = 23.8%), the committee will follow Long Term Care Institute guidelines for gradual dose reductions, behavioral interventions, and as needed psychotropic medication PRN use. This committee provides an interdisciplinary forum to discuss and implement beneficial changes to pharmacological and non-pharmacological interventions among all CLC Veterans. The committee is a valuable process for monitoring and reinforcing best practices that may be easily replicated across VA CLCs nationwide.

scholarly journals Meaningful Engagement Among Assisted Living Residents With Dementia: Successful Approaches

2021 ◽  
pp. 073346482199686
Author(s):  
Candace L. Kemp ◽  
Alexis A. Bender ◽  
Joy Ciofi ◽  
Jennifer Craft Morgan ◽  
Elisabeth O. Burgess ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Qualitative Study ◽  
Assisted Living ◽  
Care Partners ◽  
Meaningful Engagement ◽  
Care Practices ◽  
The Moment ◽  
Record Review

Meaningful engagement is an important dimension of quality of life and care for persons living with dementia, including the growing number who reside in assisted living communities. This report presents preliminary findings from an ongoing qualitative study aimed at identifying best care practices to create and maintain meaningful engagement among persons with dementia. Over a 1-year period, we conducted interviews, residents’ record review, and participant observations in four diverse care communities. Our analysis identified four approaches that successfully promote meaningful engagement: (a) knowing the person, (b) connecting with and meeting people where they are, (c) being in the moment, and (d) viewing all encounters as opportunity. Incorporation of these approaches in care routines and adoption by all care partners can promote meaningful engagement, including during crises such as COVID-19.

PSYCHOTROPIC MEDICATION WITH CHILDREN: AN EVALUATION OF PROCEDURAL BIASES IN RESULTS OF REPORTED STUDIES

PEDIATRICS ◽  
1973 ◽  
Vol 51 (3) ◽  
pp. 513-517
Author(s):  
Stephen I. Sulzbacher
Keyword(s):  
Behavior Change ◽  
Research Design ◽  
Psychotropic Medication ◽  
Clinical Results ◽  
Psychotropic Medications ◽  
Treatment Plans

A review was conducted of 753 studies on the effects of drugs on learning or behavior in children published between January 1937 and March 1971. The studies were arranged in categories based on research design, measures of behavior change, and whether clinical results were reported as significant. The analysis of these studies suggests that research design and the measure of behavior change exert a biasing influence on the degree of reported efficacy of the psychotropic medications. These factors should be taken into account when interpretations of published reports are used to decide upon treatment plans with such medications.

PRN Medication for Psychiatric Inpatients

1987 ◽  
Vol 32 (3) ◽  
pp. 199-203 ◽  
Author(s):  
John L. Craven ◽  
Peter M. Voore ◽  
George Voineskos
Keyword(s):  
Personality Disorder ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Teaching Hospital ◽  
Psychotropic Medication ◽  
Psychotropic Drugs ◽  
Psychiatric Inpatient ◽  
Psychiatric Inpatients ◽  
Psychotropic Medications ◽  
Inpatient Units

Little is known about the extent of the use of prn psychotropic medication in psychiatric inpatient units. A survey of the prn prescription and administration of psychotropic drugs in a psychiatric teaching hospital revealed that a large number of inpatients were prescribed and administered such drugs on a prn basis. Although 50% of the prescriptions were never administered, only 25% were actively discontinued by physicians. A diagnosis of personality disorder was the factor most frequently associated with the rate of prn prescriptions and of administrations. A large number of prn prescriptions had no instructions for indications, minimum time spacing between doses or maximum daily dosage. It is suggested that hospitals monitor the prn use of psychotropic medications in their inpatient units, and explore the reasons for such use. Psychotropic drug use on a prn basis should preferably be reserved for emergencies, and the instructions of prn prescriptions should be clear and detailed.

scholarly journals An audit to look at the prescribing of psychotropic medication in the general adult inpatient setting in patients with emotionally unstable personality disorder

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S31-S31
Author(s):  
Declan Hyland ◽  
Charlie Daniels ◽  
Iulian Ionescu ◽  
Christina Houghton ◽  
Katie Goodier ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Psychotropic Medication ◽  
Psychotropic Medications ◽  
Inpatient Setting ◽  
Mood Stabiliser ◽  
Supportive Psychotherapy ◽  
Psychiatric Comorbidities ◽  
Prescribing Practice ◽  
Medication Prescribing ◽  
Emotionally Unstable Personality Disorder

AimsTo assess the frequency of prescription of psychotropic medication in patients with a primary diagnosis of emotionally unstable personality disorder (EUPD) following admission to Clock View Hospital, an inpatient unit in Mersey Care NHS Foundation Trust.MethodA retrospective analysis of the electronic (RiO) record of 50 patients discharged from Clock View Hospital between 1 January 2020 and 1 November 2020 was performed to assess prescribing practice.Twenty-five patients with a diagnosis of EUPD and no associated psychiatric comorbidities were included in the sample, as well as 25 patients with a diagnosis of EUPD and associated psychiatric comorbidities.Result80% of the 25 patients with EUPD and associated psychiatric comorbidities were prescribed psychotropic medication prior to admission to hospital (56% an antidepressant, 24% a mood stabiliser, 60% an antipsychotic and 8% a benzodiazepine). 64% of patients were prescribed two or more psychotropic medications. 28% were initiated on new psychotropic medications following admission. For four of the seven prescriptions commenced on psychotropic medication, prescribing practice was as advised in Mersey Care's EUPD guidelines.Of the 25 patients with EUPD and no associated psychiatric comorbidities, 96% of the patients were prescribed psychotropic medication prior to admission to hospital (56% an antidepressant, 20% a mood stabiliser, 72% an antipsychotic and 12% a benzodiazepine). 68% of patients were prescribed two or more psychotropic medications. Following admission, 28% of patients were initiated on new regular psychotropic medications. For five of the eight prescriptions for new psychotropic medication, prescribing practice was as advised in Mersey Care's EUPD guidelines.78% of the 50 patients were prescribed as required (PRN) psychotropic medication. In 21 patients, PRN medication was prescribed for longer than one week.ConclusionThere is a higher rate of prescribing of antipsychotic prescription in those EUPD patients with no psychiatric comorbidities compared to associated psychiatric comorbidities (72% vs 60%). Surprisingly, there was a lower rate of psychotropic polypharmacy in those with psychiatric comorbidities.Use of PRN psychotropic medication for longer than a week was higher in those patients with psychiatric comorbidities compared to those without psychiatric comorbidities (58% vs 50%). Benzodiazepines were overwhelmingly the most consistently prescribed PRN medication for patients with EUPD.One action to consider would be highlighting the importance of trialling psychologically-minded interventions and supportive psychotherapy prior to initiation of psychotropic medication. There also needs to be consideration to use of the sedative antihistamine promethazine as a first-line PRN medication for acute agitation.

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