TITLE:
Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program
AUTHORS:
Kai Zhen Yap, Ee Heok Kua, Sui Yung Chan, Joyce Yu-Chia Lee
KEYWORDS:
Antipsychotics, Appropriate Prescribing, Behavioral and Psychological Symptoms of Dementia, Nursing Home, Falls
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.2,
April
29,
2014
ABSTRACT: 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