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O'Brien E, Johnston S, Douglas C. Implementing a medication lubricant for pill dysphagia on an acute care ward using Plan-Do-Study-Act cycles. BMJ Open Qual 2023; 12:e002505. [PMID: 38114248 DOI: 10.1136/bmjoq-2023-002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Pill dysphagia, the difficulty in swallowing solid oral medications, is a common problem that can affect medication adherence and increase pill modifications. Current practices of crushing medications or using food vehicles have limitations and potential risks. This report describes the implementation of a medication lubricant, Gloup, for pill dysphagia on an acute care ward using Plan-Do-Study-Act cycles. OBJECTIVE The objective of this project was to evaluate the implementation of Gloup in the acute care ward setting and assess its acceptability and uptake by patients and ward nurses during medication administration. METHODS The project involved chart audits of medication administration records, collection of patient feedback, and staff feedback through meetings. Patient characteristics and medication administration practices were documented. The implementation process included education and training sessions for staff, development of a medication chart sticker for evaluation data collection and small-scale testing of Gloup with patients before ward-level implementation. RESULTS The implementation of Gloup on the acute care ward showed high uptake and acceptability. The majority of patients using Gloup had crushed medications, and the use of Gloup varied based on patient needs. CONCLUSION The implementation of Gloup as a medication lubricant for pill dysphagia on an acute care ward was successful and well received by patients and staff. The use of Gloup appeared to improve medication administration practices and reduce the need for crushing medications or using food vehicles. This project highlights the importance of addressing pill dysphagia in acute care settings and provides insights for other wards considering similar interventions.
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Affiliation(s)
- Emma O'Brien
- Orthogeriatrics (Ward 2D), The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Sandra Johnston
- School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Office of Nursing and Midwifery Services, Metro North Hospital and Health Service, Herston, Queensland, Australia
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Andersson ÅC, Lindemalm S, Onatli D, Chowdhury S, Eksborg S, Förberg U. 'Working outside the box'-an interview study regarding manipulation of medicines with registered nurses and pharmacists at a Swedish paediatric hospital. Acta Paediatr 2023; 112:2551-2559. [PMID: 37680138 DOI: 10.1111/apa.16967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
AIM Studies on frequencies of manipulated medicines in paediatric care are common, but there is little knowledge of experiences of pharmacists and registered nurses in this area. The aim of this study was to explore registered nurses' and pharmacists' reasoning in the manipulation of medicines to paediatric inpatients. METHODS Semistructured interviews with twelve registered nurses and seven pharmacists were performed at a Swedish paediatric university hospital. The interviews were transcribed verbatim and analysed using content analysis. RESULTS Four major categories emerged from the analysis of the interviews: medicines management, knowledge, consulting others and organisation. Medicines management involved the process of drug handling, which is prescribing, reconstitution or manipulation and administration. Knowledge concerned both the knowledge base and how healthcare personnel seek information. Consulting others involved colleagues, registered nurses and pharmacists, between registered nurses, pharmacists and physicians and between registered nurses, pharmacists and caregivers. Organisation covered documentation, time and working environment. CONCLUSION Both pharmacists and registered nurses stated that manipulation of medicines to paediatric patients was often necessary but felt unsafe due to lack of supporting guidelines. Pharmacists were natural members of the ward team, contributing with specific knowledge about medicines and formulations.
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Affiliation(s)
- Åsa C Andersson
- Division of Paediatrics, ePed Central Editorial Office, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Synnöve Lindemalm
- Division of Paediatrics, ePed Central Editorial Office, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Dilba Onatli
- Division of Pharmacokinetics and Drug Therapy, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Samia Chowdhury
- Division of Pharmacokinetics and Drug Therapy, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Staffan Eksborg
- Division of Paediatrics, ePed Central Editorial Office, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Förberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Daibes MA, Qedan RI, Al-Jabi SW, Koni AA, Zyoud SH. Nurses' knowledge and practice regarding mixing medications with food: a multicenter cross-sectional study from a developing country. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:52. [PMID: 37277885 DOI: 10.1186/s41043-023-00396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Different pharmaceutical characteristics of the dosage form (DF) have a direct effect on how easily oral solid medicine is swallowed. The practice of crushing tablets or opening the capsule occurs daily in the hospital, and most nurses are unknowledgeable regarding these issues. Coadministration of medications with food can cause changes in drug absorption and lead to an alteration in gastrointestinal motility, which can cause an unexpected effect on the dissolution and absorption of the drug. Therefore, this study aimed to investigate nurses' knowledge and practices regarding the mixing of medications with food or drink in Palestine. METHODS From June 2019 to April 2020, a cross-sectional study was conducted, encompassing nurses working in government hospitals across various districts of Palestine. The data were collected through face-to-face interviews, using questionnaires that assessed nurses' understanding and implementation of mixing medications with food. The sampling method employed was convenience sampling. To analyze the gathered information, the Statistical Package for the Social Sciences version 21 (IBM-SPSS) was utilized. RESULTS A total of 200 nurses participated in the study. The data show a significant difference between the median knowledge scores according to the department of work (p < 0.001). The highest median [interquartile] knowledge score of 15 [12-15] was found for nurses working in the neonatal intensive care unit. In addition, nurses in the pediatric ward and the men's medical ward had high scores of 13 [11.5-15] and 13 [11-14], respectively. In general, the results show that 88% of nurses modified oral DF prior to administration to patients. Regarding the type of food used, mixing medicine into juice was the most common procedure performed by nurses (approximately 84%); 35% of nurses used orange juice to mix with medicine. The most common reason for crushing was to administer medications to patients with a nasogastric tube (41.5%). In regard to medications, aspirin was the most frequently used drug that was crushed by the nurses (44%); however, 35.5% of nurses did not feel sufficiently trained to carry out this practice. Concerning the sources of information, 58% of nurses usually asked pharmacists for information about medications. CONCLUSIONS The results of this study show that crushing and mixing medications with food is common among nurses, and most nurses are unaware of the dangerous effect of this practice on patient health. Pharmacists, as medication experts, should participate in sharing knowledge about unnecessary crushing situations or when crushing should be avoided and try to find an alternative, when available, to aid administration.
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Affiliation(s)
- Marah A Daibes
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Rawan I Qedan
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
| | - Amer A Koni
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Lovell AG, Protus BM, Dickman JR, Saphire ML. Palatability of Crushed Over-the-Counter Medications. J Pain Symptom Manage 2021; 61:755-762. [PMID: 32976943 DOI: 10.1016/j.jpainsymman.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Dysphagia is a common concern, especially in the last several days of life. Medications are often crushed for ease of administration for individuals with swallowing difficulty. OBJECTIVES To assess palatability of commonly used crushed over-the-counter (OTC) medications. A secondary objective is to evaluate pharmacist knowledge and opinions of crushing medications. METHODS Pharmacist participants sampled crushed OTC medications and completed presampling and postsampling surveys about crushing medications. Participants were excluded for current smoking or tobacco use, pregnancy, allergy to any study medication or applesauce, or potential drug-drug interaction with study medications. Eight OTC medications were crushed and mixed in applesauce: naproxen, fexofenadine, phenazopyridine, multivitamin, loperamide, famotidine, sennosides, and sennosides-docusate. Participants were blinded to medication samples and control (plain applesauce). Samples were rated from one (least palatable) to five (most palatable). Investigators recorded participants' comments, behaviors, and facial expressions during sampling. RESULTS Nineteen volunteers completed the study. Most participants rated three samples as not palatable (score of two or less): fexofenadine, 16 (84%); loperamide, 13 (68%); and sennosides-docusate, 16 (84%). All participants rated famotidine and sennosides palatable. The percentage of participants who would consider palatability in recommendations for crushing medications increased from 47% prestudy to 79% poststudy. CONCLUSION Palatability should be considered when recommending crushed medications. Survey responses indicate that pharmacists' opinions of crushed medications changed after this palatability experiment. Clinicians should evaluate the appropriateness of all medications when dysphagia is a concern and deprescribe medications when appropriate to reduce burden for patients and caregivers.
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Affiliation(s)
| | | | - Julia R Dickman
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Maureen L Saphire
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Solberg H, Devik SA, Bell HT, Zeiss DH, Olsen RM. Drug modification by nurses in Norwegian nursing homes: A cross-sectional study. Geriatr Nurs 2021; 42:351-357. [PMID: 33561616 DOI: 10.1016/j.gerinurse.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Crushing and dividing pills among older patients in nursing homes appears to be a common yet not harmless practice. Because few updates exist regarding the role of nurses and their dispensing of drugs in nursing homes, this study sought to describe the occurrence, methods, and causes of nurses' drug modification and to examine possible factors associated with drug modification in this context. A cross-sectional study of 273 dispensing episodes of solid oral drugs made by nurses, were observed during day and evening shifts. Modifications were made in 20.5% of the dispensing episodes, including 80.4% where alterations were made by crushing and 19.6% where alterations were made dividing. The most commonly reported reasons for modification were 'swallowing difficulties' (53.6%) and 'lack of understanding by the patient' (19.6%). The logistic regression analysis showed a significant association between the occurrence of drug modification and both cognitive impairment and administration method.
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Affiliation(s)
- Hege Solberg
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway.
| | - Siri Andreassen Devik
- Centre for Care Research Mid-Norway, Nord University, PO Box 474, 7801 Namsos, Norway
| | - Hege Therese Bell
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway; Faculty of Nursing and Health Sciences, Nord University, PO Box 93, 760 Levanger, Norway; Master in Pharmacy, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Høgskoleringen, 1, 7491 Trondheim, Norway
| | - Daniel Horst Zeiss
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway
| | - Rose Mari Olsen
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway
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Sefidani Forough A, Lau ETL, Steadman KJ, Kyle GJ, Cichero JAY, Serrano Santos JM, Nissen LM. Factors that affect health-care workers' practices of medication administration to aged care residents with swallowing difficulties: An Australia-wide survey study. Australas J Ageing 2020; 40:e79-e86. [PMID: 32985061 DOI: 10.1111/ajag.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To understand the barriers and facilitators of medication administration to aged care residents with swallowing difficulties. METHODS Health-care workers in aged care facilities across Australia involved in medication administration to residents completed an online survey. RESULTS Of 355 respondents, 90.9% reported 'everyday' encounters with residents with swallowing difficulties and 94.1% modified medications to facilitate administration. Time constraints (63.4%) and workload (69.0%) were common barriers. Only 39.0% believed swallowing abilities are considered at the prescribing stage. Pill size (95.8%), polypharmacy (75.2%) and lack of alternative formulations (74.9%) contributed to these challenges. Support from other health-care professionals (91.5%) and training (85.9%) were the most favoured facilitators. CONCLUSION Health-care workers are faced with various challenges when caring for residents with swallowing difficulties. Promoting multidisciplinary collaborations, provision of training and medication review services, and improving skill mix and staffing composition in aged care facilities are needed to address these challenges.
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Affiliation(s)
- Aida Sefidani Forough
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia
| | - Esther T L Lau
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Kathryn J Steadman
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Greg J Kyle
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia
| | - Julie A Y Cichero
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Jose Manuel Serrano Santos
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia
| | - Lisa M Nissen
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
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Sefidani Forough A, Lau ETL, Steadman KJ, Kyle GJ, Cichero JAY, Serrano Santos JM, Nissen LM. Factors affecting Australian aged care facility workers in administering oral medication to residents with swallowing difficulties. Res Nurs Health 2020; 43:419-430. [PMID: 32496618 DOI: 10.1002/nur.22042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/12/2020] [Indexed: 11/08/2022]
Abstract
Swallowing difficulties are common in older people and can complicate the administration of oral medications. The aim of this study was to explore factors affecting healthcare workers in their practices of oral medication administration to aged care residents with swallowing difficulties. A purposeful sample of 17 healthcare workers composed of clinical/care managers, registered nurses (RNs), enrolled nurses (ENs), and assistants in nursing (AINs) from three aged care facilities in Queensland, Australia participated in semi-structured interviews. Leximancer was used for quantitative content analysis. The responses centered on three main factors. Participants discussed workprocess-related factors including time, workload, and stress and frustrations resulting from work processes. Medication-related factors included strategies to facilitate medication administration, uncertainties around modifying medications, availability/cost of alternatives, multidisciplinary medication management, prescribing considerations, and polypharmacy. Resident-related factors were discussed around individualized needs of residents especially those with dementia-associated swallowing difficulties. Ideas differed among the four groups of participants. Managers discussed workprocess-related factors pertaining to staff and facility. RNs focused on how clinical aspects of the medication practices were affected by work processes. ENs were task-oriented and their responses focused on work processes. AIN responses centered on reliance on RNs in performing medication tasks. The findings suggest that healthcare workers' practices of medication administration to residents with swallowing difficulties are affected by various factors associated with work processes, medications, and resident characteristics. Although these factors affect all levels of healthcare workers, the needs of each group vary depending on their level of training and responsibilities.
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Affiliation(s)
- Aida Sefidani Forough
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Esther T L Lau
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn J Steadman
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Greg J Kyle
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Julie A Y Cichero
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Jose Manuel Serrano Santos
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Lisa M Nissen
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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Mc Gillicuddy A, Kelly M, Crean AM, Sahm LJ. Understanding the knowledge, attitudes and beliefs of community-dwelling older adults and their carers about the modification of oral medicines: A qualitative interview study to inform healthcare professional practice. Res Social Adm Pharm 2019; 15:1425-1435. [PMID: 30658913 DOI: 10.1016/j.sapharm.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/24/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Oral medicines are commonly modified (e.g. tablets split/crushed) to meet the dosing and swallowing requirements of older adults. However, there is limited research investigating the opinions of community-dwelling patients and carers about medicine modification. OBJECTIVES The aim of this study was to investigate the views of community-dwelling older adults and their carers about oral medicine modification. METHODS Semi-structured, face-to-face interviews were conducted with community-dwelling older adults and carers of older adults who experienced difficulty swallowing medicines, or who required medicines to be modified. Participants were recruited from purposively selected community pharmacies using a combination of purposive, convenience and snowball sampling. Interviews were audio-recorded, transcribed verbatim and analysed thematically. The Francis method governed when data saturation had been reached. RESULTS Twenty-six interviews (13 patients, 13 carers) were conducted (76.9% female, median length 11 min (IQR 8-16 min)). Four themes emerged from the data: variation in medical needs and preferences; balancing acceptance and resignation; healthcare professional engagement and; opportunities for optimising formulation suitability. The heterogeneity of medical conditions experienced by community-dwelling older adults resulted in a variety of modifications being required. Patients and carers are accepting of their medications and formulations. However, when challenges arise, they tend to feel resigned to coping within the constraints of the current medication regimen, resulting in a lack of focused communication with healthcare professionals. Thus, healthcare professionals were unaware of their difficulties and unable to offer advice or solutions. CONCLUSION Healthcare professionals must engage proactively with this group. Whilst a holistic approach to medication management is ideal, the disadvantage is that no single healthcare professional may identify this as their responsibility. Whilst the input and expertise of all healthcare professionals will be required, as medication experts, the pharmacy profession should take ownership and become the champion of, and for, the patient.
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Affiliation(s)
- Aoife Mc Gillicuddy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Maria Kelly
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Abina M Crean
- School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland; Pharmacy Department, Mercy University Hospital, Cork, Ireland.
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Walsh KA, Sinnott C, Fleming A, Mc Sharry J, Byrne S, Browne J, Timmons S. Exploring Antipsychotic Prescribing Behaviors for Nursing Home Residents With Dementia: A Qualitative Study. J Am Med Dir Assoc 2018; 19:948-958.e12. [PMID: 30241987 DOI: 10.1016/j.jamda.2018.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/03/2018] [Accepted: 07/07/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions. DESIGN Semistructured qualitative interviews based on the Theoretical Domains Framework (TDF). SETTING AND PARTICIPANTS A purposive sample of 27 participants from 4 nursing homes, involved in the care of nursing home residents with dementia (8 nurses, 5 general practitioners, 5 healthcare assistants, 3 family members, 2 pharmacists, 2 consultant geriatricians, and 2 consultant psychiatrists of old age) in a Southern region of Ireland. MEASURES Using framework analysis, the predominant TDF domains and determinants influencing these behaviors were identified, and explanatory themes developed. RESULTS Nine predominant TDF domains were identified as influencing appropriate antipsychotic prescribing behaviors. Participants' effort to achieve "a fine balance" between the risks and benefits of antipsychotics was identified as the cross-cutting theme that underpinned many of the behavioral determinants. On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioral symptoms, in a resource-poor environment, was emphasized. The implementation of best-practice guidelines was illustrated through 3 explanatory themes ("human suffering"; "the interface between resident and nursing home"; and "power and knowledge: complex stakeholder dynamics"), which conceptualize how different nursing homes strike this "fine balance." CONCLUSIONS Implementing evidence-based antipsychotic prescribing practices for nursing home residents with dementia remains a significant challenge. Greater policy and institutional support is required to help stakeholders strike that "fine balance" and ultimately make better prescribing decisions. This study has generated a deeper understanding of this complex issue and will inform the development of an evidence-based intervention.
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Affiliation(s)
- Kieran A Walsh
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland.
| | - Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Aoife Fleming
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland; Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - Jenny Mc Sharry
- Health Behavior Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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