Improving Medication Safety in Psychiatry – A Controlled Intervention Study of Nurse Involvement in Avoidance of Potentially Inappropriate Prescriptions

Abstract

The aim of this controlled, before-and-after study in the Department of Psychiatry in a university hospital in Denmark was to examine the potential effects and characteristics of nurses reviewing psychiatric patients' medication records to identify potentially inappropriate prescriptions (PIPs). The control group and the intervention group each consisted of two bed units chosen based on patients' diagnoses and age categories. There were 396 patients (age ≥18 years) included in the study. Senior clinical pharmacology physicians performed medication reviews for all patients in the study; these medication reviews were considered gold standard. The intervention group: nurses were given a pharmacology course after which the nurses reviewed medication lists and subsequently conferred any identified PIPs with physicians. The control group: medication was reviewed as usual and nurses did not participate. Primary outcome measure was the potential difference in PIPs between the control group and the intervention group, analysed in two ways: (i) difference in mean number of PIPs and (ii) difference in number of patients exposed to ≥1 PIP, using regression analysis with an approximated difference-in-difference (DID) approach. Secondary outcome measure was characteristics of PIPs where physicians responded to nurse-identified PIPs. The DID between intervention group and control group for mean number of PIPs per patient was -0.23 (-1.07 to 0.60), and for number of patients receiving ≥1 PIP, the odds ratio was 0.61 (0.25 to 1.46). Physicians changed most prescriptions in the category interaction between drugs. Nurses could not significantly reduce the prevalence of PIPs for psychiatric patients.

Leading 20 drug–drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients

“…There was a high incidence of PIP agent prescription in our study as can be comprehended from our results. Our findings are similar with a work conducted by Soerensen et al, 54 who reported that about 66% of their geriatric patients attending the psychiatry department of a university hospital were taking at least one PIP. In another retrospective, cross-sectional design study by Kolshus et al, 55 of the 65 patients (aged ⩾90 years), 23 (35.4%) received long-term benzodiazepines as PIP agents.…”

Structured Interventions to Optimize Polypharmacy in Psychiatric Treatment and Nursing Homes

“…The majority of studies (44 of 58) involved an individualized medication review 33,35–43,47–52,54–60,62,64–79,84,86–88 . Only few studies (16 of 48) reported active patient involvement in the review process 40–42,49,52,54–56,58–60,63,65,68,71,87 .…”

“…The percentage of female participants ranged between 7% and 78%. Only 2 studies reported somatic comorbidities 70,88 . Number of drugs before intervention ranged from 3 to 12.3 drugs per patient, with a median of 5.2.…”

“…Only 2 studies reported somatic comorbidities. 70,88 Number of drugs before intervention ranged from 3 to 12.3 drugs per patient, with a median of 5.2. Follow-up was highly variable, ranging from immediately after the intervention to 240 weeks.…”

Nurses' responsibilities and tasks in pharmaceutical care: A scoping review

“…(Choo et al., 2010 ; Nursing & Midwifery Council, 2018 ) Nurses often appear to be the last barricade between patients and medication errors, because they are well‐positioned to identify drug‐related problems and minimize unnecessary drug‐related patient harm. (Dykes et al., 2010 ; Gabe et al., 2011 ; Henneman et al., 2010 ; Jordan et al., 2015 ; Rogers et al., 2008 ; Soerensen et al., 2018 ; Ulfvarson et al., 2007 ) In a previous study, 4,888 European nurses indicated monitoring therapeutic and adverse effects of medicines, monitoring medicines adherence, prescribing medicines and providing patient education and information about medicines are part of their clinical practice activities (De Baetselier, Van Rompaey, et al., 2020 ). A subsequent large‐scale interview study was able to confirm this active role in PC (De Baetselier, Dilles, et al., 2020 ).…”