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Show Reducing the Use of PRN Psychotropic Medications Among Older Adults in the Long-Term Care Setting Kimmy Kwong, BSN, DNP Student Deborah Morgan, DNP, APRN, PMHNP-BC Key Findings: An educational intervention was noted to be an effective approach to increasing knowledge and willingness of using non-psychopharmacological interventions among geriatric nurses in the long-term care setting Results Background • Among nursing home residents, the frequency of psychotropic medication use remains high. Up to 74.6 % of older adults take scheduled psychotropic drugs, and up to 8 % take additional PRN psychotropic drugs The post-intervention analysis demonstrated a statistically significant difference in: • Improved mean score (%) of the PEAK-NH test from Pre 57.81 % (SD= 16.41) to Post 84 % (SD= 5.70; P= 0.000) Author(s) Figure 1. Summary of Post-Intervention • Improved perceived knowledge level of psychotropic medications from Pre (M= 2.57; SD= 0.93) to Post (M= 3.10; SD= 0.63; P= 0.002) Summary of Post- Survey • Higher PRN psychotropic intakes contribute to increased risk of adverse reactions include falls and consequent fracture, stroke, or even death, as well as increased hospital admission relating to adverse drug effects HOW OFTEN USE ALERTNATIVE APPROACHES 10 10 1 0 • Showed statistically significant correlation between the satisfaction of education and willingness of using alternative approaches in future (M= 3.43; SD= 0.60; CI= 0.089 to 0.77; P= 0.016) 0 PERCEIVED KNOWLEDGE LEVEL AFTER EDUCATION 5 13 3 0 0 PERCEIVED KNOWLEDGE LEVEL BEFORE EDUCATION 2 11 • Nursing home residents are the most vulnerable older adults for inappropriate PRN psychotropic drugs, as nurses tend to have a lack of knowledge/resources or overly rely on PRNs to manage symptoms 6 1 EMAR chart review for 2 months pre- and 2 months post-intervention showed: • Pre-intervention EMAR review: 35 % of residents received scheduled psychoactive medications and 8.1 % received PRN psychoactive medications 1 SATISFACTION TO EDUCATION TRAINING 18 3 0 0 0 0 excellent 2 4 above average 6 average 8 10 below average 12 14 16 18 20 Very little Methods • Setting: Two skilled nursing facilities in Salt Lake County • Administered Pre-education survey to geriatric nurses to assess their knowledge level using the validated the Psychotropic Education and Knowledge Test for Nurses in the Nursing Home (PEAK-NH) • Conducted a retrospective EMAR chart review of two consecutive months prior to the educational intervention • Developed and implemented one-on-one educational training for geriatric psychotropic medications using the Health Belief Model framework and findings from the pre-training survey Figure 2. Types of Psychotropic (%) Types of PRN Psychotropic drugs (%) Types of Psychotropic drugs ( %) 8% Figure 3. Types of PRN Psychotropic (%) 9% 9% 42% Antidepressants 24% Anxiolytics Anxiolytics 23% Sedative/hypnotics 19% Antipsychotics Other psychoactives 67% Sedative/hyponotics Other psychoactive • Post-intervention EMAR review: 23.5 % of residents received scheduled psychoactive medications and 6.6 % received PRN psychoactive medications Conclusions • Study findings support that the psychotropic medication education was effective in motivating nurses to use non-psychopharmacological approaches to reduce the frequency of PRN psychotropic medications use • Although there was a slight change in the rate of PRN psychotropic drug administration following the intervention, this might be due to the short time frame studied • Assessed effectiveness of the intervention by repeating the same PEAK-NH test and gathering subjective feedback on participants’ satisfaction of the training • Brief, additional check-ins to revisit training/identify barriers as well as additional EMAR chart reviews may be helpful • Conducted repeat EMAR chart review after completing the educational training for two consecutive months • The implementation of one-on-one educational training was effective, but it is hard to sustain; hence individual online module training may be more sustainable and also to expand it to other facilities COLLEGE OF NURSING |
