Trajectories of pro re nata (PRN) medication prescribing and administration in long-term care facilities

Sharma, Monica; Wong, Xin Yee; Bell, John; Corlis, Megan; Hogan, Michelle; Sluggett, Janet K.

doi:10.1016/j.sapharm.2020.11.003

Cited by 7 publications

(39 citation statements)

References 20 publications

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“…Study designs included observational studies (n=31), experimental studies (n=6), qualitative studies (n=2), and a methodological study (n=1) (Table 1 ). Six articles utilized data from an Australian cohort study ( 23 , 25 , 26 , 29 – 31 ), five from an Australian randomized controlled trial (RCT) ( 22 , 27 , 28 , 32 , 33 ), three from a Spanish longitudinal study ( 41 – 43 ), and three from a Chinese cross-sectional study ( 35 – 37 ). The number of participants ranged from 13 to 571,139, with a mean age range of 79.0 ± 8.8 to 89.4 ± 4.6 years.…”

Section: Resultsmentioning

confidence: 99%

“…Cross-sectional associations were described in 18 studies (Table 2 ). Fifteen studies reported univariate or bivariate associations ( 23 , 26 , 29 , 31 , 33 , 39 , 43 , 45 , 47 , 52 , 56 – 60 ); while four studies adjusted analyses for age, sex, and other variables ( 22 , 35 , 42 , 55 ). FRAIL-NH scores were associated with older age ( 35 , 39 , 47 , 55 – 57 ), female sex ( 29 , 45 , 55 – 57 ), multimorbidity ( 35 , 43 , 52 , 57 ), cognitive impairment ( 43 , 45 , 52 , 55 , 57 , 59 ), and functional dependence ( 43 , 52 ).…”

Section: Resultsmentioning

confidence: 99%

“…By 6 months, those with severe impairment were over twice as likely to be frail ( 45 ). Other applications of FRAIL-NH include: establishing baseline comparability of participants in studies ( 24 , 27 , 28 , 32 , 33 , 54 ); baseline screening as proxy to physical health for RCT recruitment ( 50 ); describing COVID-19 seroprevalence in frail residents ( 48 ); characterizing frailty status in residents interviewed on perceptions of frailty ( 21 , 34 ); examining changes in FRAIL-NH scores at annual routine screening ( 46 ); and the prospective use of FRAIL-NH in acute care ( 52 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Of the 18 cross-sectional studies, 15 studies provided clear inclusion criteria (Table S3) ( 22 – 24 , 29 , 31 , 33 , 35 – 38 , 40 , 42 , 43 , 45 , 54 ). All studies described resident characteristics and settings in detail ( 22 – 24 , 29 , 31 , 33 , 35 – 38 , 40 , 42 , 43 , 45 , 48 , 54 , 55 , 60 ). Cross-sectional associations with frailty were not investigated in seven studies ( 24 , 36 – 38 , 40 , 48 , 54 ), therefore criteria related to confounding factors were not assessed in these studies.…”

Section: Resultsmentioning

confidence: 99%

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The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Liau

Lalic

Visvanathan

et al. 2021

The Journal of nutrition, health and aging

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Objectives To investigate frailty prevalence, cross-sectional associations, predictive validity, concurrent validity, and cross-cultural adaptations of the FRAIL-NH scale. Design Systematic review. Setting and Participants Frail residents living in nursing homes. Methods MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched from January 2015 to June 2021 for primary studies that used the FRAIL-NH scale, irrespective of study designs and publication language. Results Overall, 40 studies conducted across 20 countries utilized the FRAIL-NH scale; majority in Australia (n=14), followed by China (n=6), United States (n=3), and Spain (n=3). The scale has been translated and back-translated into Brazilian Portuguese, Chinese, and Japanese. Various cut-offs have been used, with ≥2 and ≥6 being the most common cut-offs for frail and most frail, respectively. When defined using these cut-offs, frailty prevalence varied from 15.1–79.5% (frail) to 28.5–75.0% (most frail). FRAIL-NH predicted falls (n=2), hospitalization or length of stay (n=4), functional or cognitive decline (n=4), and mortality (n=9) over a median follow-up of 12 months. FRAIL-NH has been compared to 16 other scales, and was correlated with Fried’s phenotype (FP), Frailty Index (FI), and FI-Lab. Four studies reported fair-to-moderate agreements between FRAIL-NH and FI, FP, and the Comprehensive Geriatric Assessment. Ten studies assessed the sensitivity and specificity of different FRAIL-NH cutoffs, with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI, while two studies reported an optimal cut-off of ≥2 based on FI and FP, respectively. Conclusion In seven years, the FRAIL-NH scale has been applied in 20 countries and adapted into three languages. Despite being applied with a range of cut-offs, FRAIL-NH was associated with higher care needs and demonstrated good agreement with other well-established but more complex scales. FRAIL-NH was predictive of adverse outcomes across different settings, highlighting its value in guiding care for frail residents in nursing homes. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-021-1694-3 and is accessible for authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Liau

Lalic

Visvanathan

et al. 2021

The Journal of nutrition, health and aging

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Validity of Pharmaceutical Claims Data for Determining Medication Exposure in Long‐Term Care Facilities

Pearce,

Rogers,

Carpenter

et al. 2024

Pharmacoepidemiology and Drug

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PurposeTo compare the accuracy of pharmaceutical claims with medication administration chart data for individuals in long‐term care facilities (LTCFs).MethodsSecondary analyses of a prospective cohort study (n = 279 residents, 5 LTCFs) were conducted. Details of medications charted for regular administration at study enrollment were extracted from administration charts and coded using Anatomical Therapeutic Chemical (ATC) classification codes. Pharmaceutical claims for government‐subsidized medications dispensed in the 0–30, 0–60, 0–90, 0–120, and 0–180 days before study enrollment were compared to medication chart data (reference standard). Sensitivity, specificity, and positive predictive value (PPV) and 95% CIs were determined at the 3‐ and 7‐digit ATC levels.Results149 (53.4% of total) residents with both medication chart and claims data available were included. The proportion of PPVs ≥ 75% for 3‐digit ATC level medications was 89.4% and 86.1% using exposure windows of 30 and 180‐days for claims, respectively. Using a 120‐day exposure window for claims, sensitivity was highest for diabetes agents, beta‐blocking agents, calcium channel blockers, agents acting on the renin‐angiotensin system, anti‐Parkinson drugs, psychoanaleptics, and airways disease agents (all ≥ 90%) and was lowest for vitamins (1.4%, 95% CI 0–7.7) and mineral supplements (10.3%, 95% CI 2.9–24.2). Specificity was ≥ 85% for all 3‐digit level medications within each exposure window other than antibacterials and analgesics.ConclusionPharmaceutical claims data has good accuracy for determining prescription medication exposure in LTCFs. Exposure windows of 90‐120‐days are generally sufficient for determining exposure although longer periods may be required for large pack sizes.

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Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

et al. 2023

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Background Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). Objective The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. Methods Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study ( N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. Results Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. Conclusions Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01025-5.

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Trajectories of pro re nata (PRN) medication prescribing and administration in long-term care facilities

Cited by 7 publications

References 20 publications

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Validity of Pharmaceutical Claims Data for Determining Medication Exposure in Long‐Term Care Facilities

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

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