Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial
Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial
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DOI：
10.1371/journal.pone.0140203
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发表时间：
2015-10-13
期刊：
影响因子：
3.7
通讯作者：
Dennis, Michael S.
中科院分区：
文献类型：
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作者：
Jordan, Susan;Gabe-Walters, Marie Ellenor;Dennis, Michael S.
研究背景痴呆患者易发生药物不良反应（ADRs）。然而，他们并不总是密切监测与他们的药物有关的潜在问题：结构化的护士领导的ADR档案有可能解决这一护理差距。我们的目的是评估临床问题的数量和性质，并解决和处方的变化后，引入护士主导的药物监测。设计实用的队列步进楔形集群随机对照试验（RCT）的结构化护士主导的药物监测与常规护理。设置五个英国私营部门的护理homespants 41服务用户，服用至少一种抗精神病药，抗抑郁药或抗癫痫药。干预护士完成西威尔士ADR（WWADR）根据试验步骤，每个参与者的心理健康药物概况。结果解决的问题和处方药物的变化。数据收集和分析信息收集自参与者随机分配前和每次分配后的笔记。五个月的试用期。发现的问题，采取的行动和减少心理健康药物的配置文件的影响进行了探讨，在多变量分析，占数据收集的步骤和site.Results5的10个网站和43的49个服务用户接触参加。Profile管理将解决的问题数量从平均值6.02 [SD 2.92]增加到9.86 [4.48]，效应量3.84，95%CI 2.57-4.11，P < 0.001。例如，疼痛更有可能得到治疗（调整后的比值比[aOR] 3.84，1.78-8.30），更多的患者去看牙医和眼镜商（aOR分别为52.76 [11.80-235.90]和5.12 [1.45-18.03]）。配置文件的使用与减少心理健康药物（aOR 4.45，1.15-17.22）。ConclusionThe WWADR配置文件的心理健康药物可以提高护理的质量和安全性，并值得进一步调查作为一项战略，以减轻已知的处方药的不良反应。
BackgroundPeople 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.DesignPragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.SettingFive UK private sector care homesParticipants41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.InterventionNurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.OutcomesProblems addressed and changes in medicines prescribed.Data Collection and AnalysisInformation 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.ResultsFive 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).ConclusionThe 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.