A Quality Improvement Intervention to Reduce the Use of PRN Psychotropic Medications Among Older Adults in the Long-Term Care Setting

Problem: Even with our increasing knowledge about the limited effectiveness and severe side effects of PRN psychotropic medications, the frequency of their use in the geriatric population remains high. Higher drug intake and potentially inappropriate PRN psychotropic medication administration contribute to a higher risk of adverse reactions such as falls and consequent fracture, stroke, or even death as well as increased hospital admission relating to adverse drug effects. Older adults in nursing homes are the most vulnerable individuals for potentially inappropriate PRN psychotropic drug use because either nurses tend to have a lack of knowledge of PRN psychotropic indications and side effects or they overly rely on PRNs without considering alternative nonpharmacological intervention. This project examined the efficacy of psychotropics education training to reduce the rate of PRN psychotropic medication administration among older adults in the long-term care setting. Methods: The study used a repeated-measures pre-/post-test design among a sample of 21 geriatric nurses in skilled nursing facilities. The Psychotropic Education and Knowledge Test for Nurses in the Nursing Home (PEAK-NH) test was administered before and after directly after the educational training. Additionally, subjective feedback was obtained to gauge the participants' satisfaction with the training. A pre- and post-intervention EMAR chart review was also conducted to analyze any change in the rate of PRN psychotropic medication administration. Results: Paired sample t-tests revealed a significant improvement in the PEAK-NH test score after the education session (mean percentage from pretest 57.81% to posttest 84%, P=0.000 (P<0.01)), and perceived knowledge level about psychotropic medication. EMAR review results showed, 35% of facility residents for 2 months, with an additional 8.1% PRN psychotropic medication used before the educational intervention was conducted. Whereas, 23.5% of residents used psychoactive medications, with an additional 6.6% of PRN psychotropic medications used for 2 months after the educational intervention was conducted. The retrospective EMAR chart review of the frequency rate of PRN psychotropic medication administration for 2 months before/after educational intervention demonstrated a weak correlation in the Pearson R-value= -0.48, and P=0.796 (P< 0.01). Conclusions: Psychotropic medication education may provide essential knowledge for promoting an understanding of the appropriate psychotropic medication uses for older adults. The lack of a statistical difference in the frequency of PRN psychotropic medication before/after the educational intervention likely indicates possible gaps between perceived knowledge and actual implementation to manage behavioral and psychological symptoms. The retrospective EMAR chart review may suggest that the data are preliminary and that a follow-up, long-term study of the frequency of PRN psychotropic medication for measuring education efficacy and identifying residual barriers may be useful.