Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

Susan Jordan; Marie Ellenor Gabe-Walters; Alan Watkins; Ioan Humphreys; Louise Newson; Sherrill Snelgrove; Michael S Dennis

doi:10.1371/journal.pone.0140203

Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

PLoS One. 2015 Oct 13;10(10):e0140203. doi: 10.1371/journal.pone.0140203. eCollection 2015.

Authors

Susan Jordan¹, Marie Ellenor Gabe-Walters¹, Alan Watkins², Ioan Humphreys¹, Louise Newson¹, Sherrill Snelgrove¹, Michael S Dennis²

Affiliations

¹ College of Human and Health Sciences, Swansea University, Swansea, Wales.
² College of Medicine, Swansea University, Swansea, Wales.

Abstract

Background: People 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.

Design: Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.

Setting: Five UK private sector care homes.

Participants: 41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.

Intervention: Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.

Outcomes: Problems addressed and changes in medicines prescribed.

Data collection and analysis: Information 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.

Results: Five 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).

Conclusion: The 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.

Trial registration: ISRCTN 48133332.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Dementia / drug therapy
Dementia / pathology*
Demography
Drug Monitoring*
Female
Humans
Male
Nurses*
Patient Care*
Prescription Drugs / therapeutic use

Substances

Prescription Drugs

Grants and funding

This work was funded and supported by the Wales School for Primary Care Research, National Institute for Social Care and Health Research, Cardiff (http://www.wspcr.ac.uk/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.