scholarly journals Factors associated with the decision to prescribe and administer antipsychotics for older people with delirium: a qualitative descriptive study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047247
Author(s):  
Emily J Tomlinson ◽  
Helen Rawson ◽  
Elizabeth Manias ◽  
Nicole (Nikki) M Phillips ◽  
Peteris Darzins ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Health Professionals ◽  
Acute Care Hospital ◽  
Nursing Workload ◽  
Care Hospital ◽  
Antipsychotic Medications ◽  
Factors Associated ◽  
Multiple Factors ◽  
Qualitative Descriptive

ObjectivesTo explore factors associated with decision-making of nurses and doctors in prescribing and administering as required antipsychotic medications to older people with delirium.DesignQualitative descriptive.SettingTwo acute care hospital organisations in Melbourne, Australia.ParticipantsNurses and doctors were invited to participate. Semi-structured focus groups and individual interviews were conducted between May 2019 and March 2020. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis.ResultsParticipants were 42 health professionals; n=25 nurses and n=17 doctors. Themes relating to decisions to use antipsychotic medication were: safety; a last resort; nursing workload; a dilemma to medicate; and anticipating worsening behaviours. Nurses and doctors described experiencing pressures when trying to manage hyperactive behaviours. Safety was a major concern leading to the decision to use antipsychotics. Antipsychotics were often used as chemical restraints to ‘sedate’ a patient with delirium because nurses ‘can’t do their job’. Results also indicated that nurses had influence over doctors’ decisions despite nurses being unaware of this influence. Health professionals’ descriptions are illustrated in a decision-making flowchart that identifies how nurses and doctors navigated decisions regarding prescription and administration of antipsychotic medications.ConclusionsThe decision to prescribe and administer antipsychotic medications for people with delirium is complex as nurses and doctors must navigate multiple factors before making the decision. Collaborative support and multidisciplinary teamwork are required by both nurses and doctors to optimally care for people with delirium. Decision-making support for nurses and doctors may also help to navigate the multiple factors that influence the decision to prescribe antipsychotics.

scholarly journals Can This Patient Be Discharged Home? Factors Associated With At-Home Death Among Patients With Cancer

2011 ◽  
Vol 29 (9) ◽  
pp. 1159-1167 ◽  
Author(s):  
Alberto Alonso-Babarro ◽  
Eduardo Bruera ◽  
María Varela-Cerdeira ◽  
María Jesús Boya-Cristia ◽  
Rosario Madero ◽  
...  
Keyword(s):  
Social Support ◽  
Decision Making ◽  
Perceived Social Support ◽  
Acute Care Hospital ◽  
Place Of Death ◽  
Care Hospital ◽  
Home Death ◽  
Factors Associated ◽  
Decision Making Model ◽  
At Home

Purpose The purpose of this study was to identify factors associated with at-home death among patients with advanced cancer and create a decision-making model for discharging patients from an acute-care hospital. Patients and Methods We conducted an observational cohort study to identify the association between place of death and the clinical and demographic characteristics of patients with advanced cancer who received care from a palliative home care team (PHCT) and of their primary caregivers. We used logistic regression analysis to identify the predictors of at-home death. Results We identified 380 patients who met the study inclusion criteria; of these, 245 patients (64%) died at home, 72 (19%) died in an acute-care hospital, 60 (16%) died in a palliative care unit, and three (1%) died in a nursing home. Median follow-up was 48 days. We included the 16 variables that were significant in univariate analysis in our decision-making model. Five variables predictive of at-home death were retained in the multivariate analysis: caregiver's preferred place of death, patients' preferred place of death, caregiver's perceived social support, number of hospital admission days, and number of PHCT visits. A subsequent reduced model including only those variables that were known at the time of discharge (caregivers' preferred place of death, patients' preferred place of death, and caregivers' perceived social support) had a sensitivity of 96% and a specificity of 81% in predicting place of death. Conclusion Asking a few simple patient- and family-centered questions may help to inform the decision regarding the best place for end-of-life care and death.

scholarly journals Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital

2019 ◽  
Vol 13 (3) ◽  
pp. 192-199
Author(s):  
Hai-Won Yoo ◽  
Myo-Gyeong Kim ◽  
Doo-Nam Oh ◽  
Jeong-Hae Hwang ◽  
Kun-Sei Lee
Keyword(s):  
Older Adults ◽  
Acute Care ◽  
Functional Decline ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Factors Associated

scholarly journals Mental health professionals’ experiences with shared decision-making for patients with psychotic disorders: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Espen W. Haugom ◽  
Bjørn Stensrud ◽  
Gro Beston ◽  
Torleif Ruud ◽  
Anne S. Landheim
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Psychotic Disorders ◽  
Successful Implementation ◽  
Practical Training ◽  
Shared Decision ◽  
Antipsychotic Medications

Abstract Background Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient’s preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals’ experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals’ SDM experiences with patients with psychotic disorders. Methods Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis. Results Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them. Conclusion Health professionals’ understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.

The Ethics of Decision Making for the Critically Ill Elderly

1995 ◽  
Vol 4 (2) ◽  
pp. 135-141
Author(s):  
Madelyn Anne Iris
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Critically Ill ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Nursing Facilities ◽  
Term Care ◽  
Institutional Ethics ◽  
Home Based ◽  
End Of Life Issues

The ethics of decision making for the critically ill elderly is an area of concern for all those involved in the decision-making process. The number of participants involved in decision making around end-of-life issues may be many: treatment and care decisions often bring together not only the patient and the physician, but the family, an extended medical care team, and impartial members of a hospital or institutional ethics committee. In addition, treatment and care decisions made at the end of life occur in a variety of settings, not just the acute care hospital. Elderly patients who are critically ill, or in the final days or weeks of life, are found in intensive care or medical units of hospitals, in hospital and nursing home based hospice programs, in long-term care settings such as skilled nursing facilities, or at home, where they are tended by family caregivers. Differences in patterns of decision making regarding the care and treatment of critically ill older adults can be found across these settings, and decisions often vary according to the roles of the participants.

scholarly journals The Experience of Older People in the Shared Decision-Making Process in Advanced Kidney Care

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Nicola Thomas ◽  
Karen Jenkins ◽  
Breeda McManus ◽  
Brian Gracey
Keyword(s):  
Decision Making ◽  
Older People ◽  
Shared Decision Making ◽  
Daily Living ◽  
Research Training ◽  
Research Process ◽  
Shared Decision ◽  
Qualitative Descriptive ◽  
First Time

Introduction. This qualitative descriptive study was designed to understand the experiences of older people (>70 years) when making a decision about renal replacement therapy. This was a coproduced study, whereby patients and carers were involved in all aspects of the research process.Methods. A Patient and Carer Group undertook volunteer and research training. The group developed the interview questions and interviewed 29 people who had commenced dialysis or made a decision not to have dialysis. Interview data were transcribed and analysed, and common themes were identified.Results. 22 men and 7 women (mean age 77.4 yrs) from two hospitals were interviewed. 18 had chosen haemodialysis, 6 peritoneal dialysis, and 5 supportive care. The majority of patients were involved in the dialysis decision. Most were satisfied with the amount of information that they received, although some identified that the quality of the information could be improved, especially how daily living can be affected by dialysis.Conclusion. Our findings show that overall older patients were involved in the dialysis decision along with their families. Our approach is innovative because it is the first time that patients and carers have been involved in a coproduced study about shared decision-making.

scholarly journals Adequacy of antidote stocking in British Columbia hospitals: The 2005 Antidote Stocking Study

CJEM ◽  
2006 ◽  
Vol 8 (06) ◽  
pp. 409-416 ◽  
Author(s):  
Matthew O. Wiens ◽  
Peter J. Zed ◽  
Katherine J. Lepik ◽  
Riyad B. Abu-Laban ◽  
Jeffrey R. Brubacher ◽  
...  
Keyword(s):  
British Columbia ◽  
Hospital Pharmacy ◽  
Acute Care Hospital ◽  
Future Research ◽  
Care Hospital ◽  
Small Hospital ◽  
Hospital Size ◽  
Information Centre ◽  
Factors Associated ◽  
Made In

ABSTRACTBackground:Inadequate hospital stocking and the unavailability of essential antidotes is a worldwide problem with potentially disastrous repercussions for poisoned patients. Research indicates minimal progress has been made in the resolution of this issue in both urban and rural hospitals. In response to this issue the British Columbia Drug and Poison Information Centre developed provincial antidote stocking guidelines in 2003. We sought to determine the compliance with antidote stocking in BC hospitals and any factors associated with inadequate supply.Methods:A 2-part survey, consisting of hospital demographics and antidote stocking information, was distributed in 2005 to all acute care hospital pharmacy directors in BC. The 32 antidotes examined (21 deemed essential) and the definitions of adequacy were based on the 2003 BC guidelines. Availability was reported as number of antidotes stocked per hospital and proportion of hospitals stocking each antidote. For secondary purposes, we assessed factors potentially associated with inadequate stocking.Results:Surveys were completed for all 79 (100%) hospitals. A mean of 15.6 ± 4.9 antidotes were adequately stocked per hospital. Over 90% of hospitals had adequate stocks ofN-acetylcysteine, activated charcoal, naloxone, calcium salts, flumazenil and vitamin K; 71%–90% had adequate dextrose 50% in water (D50W), ethyl alcohol or fomepizole, polyethylene glycol electrolyte solution, protamine sulfate, and cyanide antidotes; 51%–70% had adequate folic acid, glucagon, methylene blue, atropine, pralidoxime, leucovorin, pyridoxine, and deferoxamine; and <50% had adequate isoproterenol and digoxin immune Fab. Only 7 (8.9%) hospitals sufficiently stocked all 21 essential antidotes. Factors predicting poor stocking included small hospital size (p < 0.0001), isolation (p = 0.01) and rural location (p < 0.0001).Conclusion:Although antidote stocking has improved since the implementation of the 2003 guidelines, essential antidotes are absent in many BC hospitals. Future research should focus on determining the reasons for this situation and the effects of corrective interventions.

scholarly journals Predictors of Transfer to Different Facility at Discharge in Patients Admitted with Hematologic Malignancy: A Nationwide Inpatient Sample (NIS) Database Analysis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2132-2132
Author(s):  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
Rohit Kumar ◽  
Olekdandra Lupak ◽  
Philip Kuriakose
Keyword(s):  
Regression Analysis ◽  
Inpatient Care ◽  
Primary Outcome ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Multivariate Logistic Regression Analysis ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Multivariate Logistic Regression ◽  
Factors Associated

Background: Improvement in cancer treatment has led to an increase in prevalence of hematological malignancies with a rise in healthcare utilization secondary to this. We aim to identify predictive factors for transfer to another non-acute facility (including nursing home, subacute rehab and other institutional care) at the time of discharge. Methods: This is a retrospective cohort analysis of NIS database from 2014. Inclusion criteria was any admission of adults (≥18 years) with hematological malignancy (identified by ICD-9-CM diagnosis codes). We identified subgroups of hematological malignancies as follows: multiple myeloma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute myeloid and lymphoid leukemia, chronic myeloid and lymphoid leukemias. Patients transferred in from a different acute care hospital or another type of health facility were excluded. Aggressive inpatient care was defined by use of mechanical ventilation, vasopressors, hemodialysis (end stage renal disease excluded) or cardiopulmonary resuscitation. Primary outcome was transfer upon discharge to a different facility excluding acute care hospital (transfer out). Factors associated with this outcome were analyzed using multivariate logistic regression analysis. Statistical analysis was done using STATA. Results: There were 505,230 admissions of patients with hematological malignancy in the year 2014. Of the entire study population, 15.5% (n= 78,390) were transferred out at discharge and the most common primary diagnosis at admission for them was unspecified septicemia. Among those who were transferred out, mean age was 75.4 years (compared to 63.3 years for those not transferred out), mean length of stay was 9.7 days (compared to 6.7 days for those not transferred out) and 75.1% had Charlson Comorbidity Index (CCI) ≥3 (compared to 55.9% for those not transferred out). Also, among those who were transferred out, admission was elective in only 12.6% (compared to 24.9% for those not transferred out), aggressive inpatient care was utilized in 7.8% (compared to 2.1% for those not transferred out) and inpatient chemotherapy was given in 7.2% admissions (compared to 23.3% for those not transferred out). Breakdown of type of insurance for the two cohorts is shown in table 1. Result of multivariate logistic regression analysis for factors associated with primary outcome (transfer out) are summarized in table 2. We adjusted for the factors listed in the table and others such race, mean income quartile of patient's zip-code, hospital factors (urban or rural location, teaching status, geographical region and bed-size) and day of admission (weekend or weekday). Conclusion: Among admissions of patients with hematological malignancies, older age, female gender, presence of co-morbidities, longer length of stay, diagnosis of myeloma and chronic leukemias were associated with higher odds of transfer to a different non-acute facility at discharge. Whereas, elective admission, insurance type other than medicare, diagnosis of acute leukemias and those receiving inpatient chemotherapy had lower odds of being transferred to a different non-acute facility at discharge. A future area of exploration is development of a scoring system using the most clinically relevant and strongly associated factors to predict risk of transfer to a different non-acute facility at discharge. This will allow early decision making and mobilization of resources by healthcare systems for these patients with complex healthcare needs. Disclosures Kuriakose: Alexion: Consultancy, Honoraria, Speakers Bureau; Bayer: Consultancy.

scholarly journals A time–motion observation study to measure and analyse clinical nursing workload in an acute care hospital in Singapore

2019 ◽  
Vol 28 (2) ◽  
pp. 124-128 ◽  
Author(s):  
Mei Ling Lim ◽  
Shin Yuh Ang
Keyword(s):  
Acute Care Hospital ◽  
Recruitment Rate ◽  
Nursing Workload ◽  
Care Hospital ◽  
Work Processes ◽  
Observation Study ◽  
Staff Members ◽  
Time Motion ◽  
Motion Study ◽  
Working Shift

Internationally, there are concerns about rising nursing workforce shortages, which could be attributed to both recruitment and retention issues. As the population rapidly ages in Singapore, there is an increase in demand for more trained nurses to staff new facilities. Given the problem that Singapore is facing, there is a need for other solutions besides increasing recruitment rate. A time-motion study of nurses’ workload can assist us in determining how and what nurses spend their time on during their working shift. Work processes can then be studied to allow for improvements and implementation of strategies to ease nurses’ workload. Results of the current study demonstrated four main processes (preparing and clearing requisites, documentation, care coordination, transportation) that can be improved upon. Some of these processes do not require dedicated nursing skills; and can potentially be performed for other staff members. Results also demonstrated that nurses spent significantly less time on patient care activities as compared to nurses in United States; with as much as 31% of the nurses’ time being spent on documentation. Future studies can target on the effectiveness of strategies to improve the efficiency and quality of nursing care.

scholarly journals Covid-19 Mortality in an Acute Care Hospital: Association of Patient Factors With Decision to Forego the Intensive Care Unit

2021 ◽  
pp. 104990912110288
Author(s):  
Barry R. Meisenberg ◽  
Sadaf Qureshi ◽  
Monika Thandalam Somasekar ◽  
Qurat Ali ◽  
Mitchell Karpman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Public Awareness ◽  
Acute Care Hospital ◽  
Normal Body Mass Index ◽  
Care Hospital ◽  
Patient Factors ◽  
Goals Of Care ◽  
Factors Associated ◽  
Poor Outcomes ◽  
Time Of Admission

Background: Public awareness of the large mortality toll of COVID-19 particularly among elderly and frail persons is high. This public awareness represents an enhanced opportunity for early and urgent goals-of-care discussions to reduce medically ineffective care. Objective: To assess the end-of-life experiences of hospitalized patients dying of COVID-19 with respect to identifying the clinical factors associated with utilization or non-utilization of the ICU. Methods: Retrospective cohort study of hospital outcomes using electronic medical records and individual chart review from March 15, 2020 to October 15, 2020 of every patient with a COVID-19 diagnosis who died or was admitted to hospice while hospitalized. Logistic regression multivariate analysis was used to identify the clinical and demographic factors associated with non-utilization of the ICU. Results: 133/749 (18%) of hospitalized COVID-19 patients died or were admitted to hospice as a result of COVID-19. Of the 133, 66 (49.6%) had no ICU utilization. In multivariate analysis, the significant patient factors associated with non-ICU utilization were increasing age, normal body mass index, and the presence of an advanced directive calling for limited life sustaining therapies. Race and residence at time of admission (home vs. facility) were significant only in the unadjusted analyses but not in adjusted. Gender was not significant in either form of analyses. Conclusion: Goals of care discussions performed by an augmented palliative care team and other bedside clinicians had renewed urgency during COVID-19. Large percentages of patients and surrogates, perhaps motivated by public awareness of poor outcomes, opted not to utilize the ICU.

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