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Nurse-led medicines’ monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement initiative for mental health medicines: An observational and interview study

Sue Jordan Orcid Logo, Timothy Banner, Marie Gabe-Walters, Jane M. Mikhail, Gerwyn Panes, Jeff Round, Sherrill Snelgrove, Mel Storey, David Hughes

PLOS ONE, Volume: 14, Issue: 9, Start page: e0220885

Swansea University Authors: Sue Jordan Orcid Logo, David Hughes

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Abstract

This study investigated the implementation and clinical impact of an Adverse Drug Reaction Profile (ADRe) used to assess the prescription regimes of older residents of nursing and care homes. Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. T...

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Published in: PLOS ONE
ISSN: 1932-6203
Published: 2019
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa51807
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Abstract: This study investigated the implementation and clinical impact of an Adverse Drug Reaction Profile (ADRe) used to assess the prescription regimes of older residents of nursing and care homes. Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales.Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [1–2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation.
College: College of Human and Health Sciences
Issue: 9
Start Page: e0220885