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Purpose: Behavioral and psychological symptoms of dementia (BPSD) contribute significantly to disability, patient distress, and caregiver burden. In the nursing home setting, the use of psychotropic agents to manage BPSD depends heavily on nurses’ observational feedback. Therefore, objective monitoring of BPSD and the associated adverse effects of psychotropic use is pivotal to ensure appropriate use of these agents. For this purpose, a Psychotropic Use Monitoring (PUM) form was developed by a multi-disciplinary team consisting of geriatricians, psychiatrists, nursing officers and clinical pharmacists. The aim of this study was to evaluate the outcomes from the implementation of PUM in a Volunteer Welfare Organization-run nursing home (NH).
Methods: PUM consists of two assessments: (1) symptoms and severity of BPSD and (2) adverse effects of psychotropics. In addition to usual care, PUM was implemented and carried out over 24 weeks among the nursing staff in the dementia ward of the participating NH. Training on PUM was provided by a clinical pharmacist. Data pertinent to the use of psychotropics before and after the implementation, particularly antipsychotics, from all residents in the ward were evaluated. Feedback on PUM was also sought from each nursing staff through face-to-face interviews.
Results: After implementing PUM, there was a 3 mg decrease in the average daily chlorpromazine equivalent doses used among residents; and a 38% increase in the total number of antipsychotic dose adjustments made by the visiting psychiatrist. There was also a 50% reduction in the number of adverse incidents, such as falls and non-fall related injuries, reported in the dementia ward. Furthermore, the nursing staff indicated feeling more confident and less stressed when caring for the residents.
Conclusion: From the preliminary results, PUM improved the use of antipsychotics to manage BPSD in the nursing home, and reduced the prevalence of adverse incidents reported.