Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial.
<h4>Background</h4>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 t...
| Principais autores: | , , , , , , |
|---|---|
| Formato: | Artigo |
| Idioma: | English |
| Publicado em: |
Public Library of Science (PLoS)
2015-01-01
|
| coleção: | PLoS ONE |
| Acesso em linha: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0140203&type=printable |
| _version_ | 1826584265428566016 |
|---|---|
| author | Susan Jordan Marie Ellenor Gabe-Walters Alan Watkins Ioan Humphreys Louise Newson Sherrill Snelgrove Michael S Dennis |
| author_facet | Susan Jordan Marie Ellenor Gabe-Walters Alan Watkins Ioan Humphreys Louise Newson Sherrill Snelgrove Michael S Dennis |
| author_sort | Susan Jordan |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Design</h4>Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.<h4>Setting</h4>Five UK private sector care homes.<h4>Participants</h4>41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.<h4>Intervention</h4>Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.<h4>Outcomes</h4>Problems addressed and changes in medicines prescribed.<h4>Data collection and analysis</h4>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.<h4>Results</h4>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 <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22).<h4>Conclusion</h4>The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.<h4>Trial registration</h4>ISRCTN 48133332. |
| first_indexed | 2024-12-19T05:59:10Z |
| format | Article |
| id | doaj.art-a27a5c8b0c814dd0a89fd41b128247b1 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2025-03-14T15:35:00Z |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a27a5c8b0c814dd0a89fd41b128247b12025-02-25T05:33:41ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-011010e014020310.1371/journal.pone.0140203Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial.Susan JordanMarie Ellenor Gabe-WaltersAlan WatkinsIoan HumphreysLouise NewsonSherrill SnelgroveMichael S Dennis<h4>Background</h4>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.<h4>Design</h4>Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.<h4>Setting</h4>Five UK private sector care homes.<h4>Participants</h4>41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.<h4>Intervention</h4>Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.<h4>Outcomes</h4>Problems addressed and changes in medicines prescribed.<h4>Data collection and analysis</h4>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.<h4>Results</h4>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 <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22).<h4>Conclusion</h4>The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.<h4>Trial registration</h4>ISRCTN 48133332.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0140203&type=printable |
| spellingShingle | Susan Jordan Marie Ellenor Gabe-Walters Alan Watkins Ioan Humphreys Louise Newson Sherrill Snelgrove Michael S Dennis Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. PLoS ONE |
| title | Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. |
| title_full | Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. |
| title_fullStr | Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. |
| title_full_unstemmed | Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. |
| title_short | Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. |
| title_sort | nurse led medicines monitoring for patients with dementia in care homes a pragmatic cohort stepped wedge cluster randomised trial |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0140203&type=printable |
| work_keys_str_mv | AT susanjordan nurseledmedicinesmonitoringforpatientswithdementiaincarehomesapragmaticcohortsteppedwedgeclusterrandomisedtrial AT marieellenorgabewalters nurseledmedicinesmonitoringforpatientswithdementiaincarehomesapragmaticcohortsteppedwedgeclusterrandomisedtrial AT alanwatkins nurseledmedicinesmonitoringforpatientswithdementiaincarehomesapragmaticcohortsteppedwedgeclusterrandomisedtrial AT ioanhumphreys nurseledmedicinesmonitoringforpatientswithdementiaincarehomesapragmaticcohortsteppedwedgeclusterrandomisedtrial AT louisenewson nurseledmedicinesmonitoringforpatientswithdementiaincarehomesapragmaticcohortsteppedwedgeclusterrandomisedtrial AT sherrillsnelgrove nurseledmedicinesmonitoringforpatientswithdementiaincarehomesapragmaticcohortsteppedwedgeclusterrandomisedtrial AT michaelsdennis nurseledmedicinesmonitoringforpatientswithdementiaincarehomesapragmaticcohortsteppedwedgeclusterrandomisedtrial |