In nursing homes,
antipsychotic prescribing decisions (APDs) for managing behavioral and
psychological symptoms of dementia (BPSD) depend on the nursing staff’s
feedback. Inappropriate APDs can result in the lack of timeliness, objectivity
and important clinical information when nursing staff’s feedback on residents’
behavior and pharmacotherapy outcomes. Currently, there are no reported
interventions for improving psychiatrists’ APDs through nursing staff’s
monitoring and feedback processes. This one-group pre-and-post pilot study
aimed to evaluate the feasibility and impact of implementing a newly-developed
Psychotropic Use Monitoring (PUM) program for improving the appropriateness of
APDs in a 50-bed dementia ward of a nursing home. The PUM intervention involved
16 pharmacist-trained nursing staff, who monitored and reported residents’ BPSD
changes and psychotropic side effects for 24 weeks, while carrying out their
routine care duties. A face-to-face interview was then administered to
determine the nursing staff’s perceptions of PUM. Data of 51 residents were
collected from hardcopy individual patient records to evaluate the changes in
APDs and the number of resident falls before and after implementing PUM. The
nursing staff reported increases in their knowledge, awareness, confidence, and
actual frequency of monitoring for side effects, as well as their ability in
differentiating and managing BPSD (p < 0.05). After PUM, there was a significant
increase in the number of APDs due to side effect-related reasons (4 versus 16)
(p < 0.031). Although not significant, the number of APDs with no documented
reasons (5 versus 9) and the number of resident falls (7 versus 15) appeared to
be lesser after PUM. This study demonstrated the nursing staff’s positive
participation in PUM intervention, specifically in monitoring and feedback of
side effects. Furthermore, a potential exists for PUM to encourage more
judicious APDs, which may be useful in settings with heavy patient load,
limited human resources and dependence on foreign nursing staff from differing
cultural backgrounds.