Medication monitoring for people with dementia in care homes: a pre-pilot before and after study

Lead researcher
Dr Sue Jordan, Swansea University

Research team
Marie Gabe (researcher) BN., BSc., RN.
Sherrill Snelgrove PhD, M.Phil, BSc, RGN, lecturer in psychology applied to nursing
Gerwyn Panes RMN., MSc., BSc., LPE (PGCE). Co-ordinator BN nursing mental health
Ian Russell, Professor of Clinical Trials, Director WWORTH
Peter Huxley, Professor of Social Work; Director MHRNC
Mick Dennis, Professor of Liaison and Old Age Psychiatry.
Ceri Phillips, Professor of Health Economics

Background
Older adults with dementia are vulnerable to the well known adverse effects of medicines prescribed for mental health problems. However, they are rarely monitored for possible adverse reactions to their medicines.

Aims
To explore the introduction of a structure nurse-led medication monitoring profile.

Design
This pre-pilot ‘before and after’ study explored the operation of and any preliminary clinical gains from medication monitoring in homes caring for service users with dementia.

Participants and setting
11 patients diagnosed with dementia taking at least one of: antipsychotics, antidepressants or anti-epileptics in 3 care homes in SW Wales.

Methods
Care home nurses were asked to seek consent of patients’ next of kin and complete the ADR profile during usual care and contact with patients. This involved observing or questioning patients and seeking information from patients’ records. Researchers transcribed information from the completed profiles and extracted data from patients’ case notes to: a) seek evidence of previous medication monitoring b) ascertain whether information on the ADR profile had already been captured c) what actions were planned following administration of the ADR profile. Findings were described using IBM SPSS v.19

Results
The profile identified previously undocumented problems for all patients: mean 12.7 [4.7], range 8-21. Some problems, such as posture and movement disorders, postural hypotension and fluid intake were monitored for the first time. New problems identified and actioned included: pain (2 patients), abnormal movements (4 patients), postural hypotension (2 patients). Nurses indicated that they intended to improve liaison with dentists and increase oral care. Not all problems identified were actioned: mean number of actions 3.0, -0.6-6.6 possibly because the nurses were aware of the problems, even if undocumented. The profile took 20-25 minutes to implement, caused no harm, and was seen as comprehensive.

Conclusions
The profile improved the process of care, but longer-term follow up is needed to demonstrate an effect on clinical outcomes. Patients are likely to benefit from structured nurse-led medication monitoring, but without a full clinical trial, profiles are unlikely to be widely adopted in routine care.

Publication
Jordan S, Gabe M, Newson L, Snelgrove S, Panes G, Picek A, Russell IT, Dennis M. (2014) "Medication Monitoring for People with Dementia in Care Homes:  the Feasibility and Clinical Impact of Nurse-led monitoring," The Scientific World Journal, vol. 2014, Article ID 843621, 11 pages, 2014. doi:10.1155/2014/843621. http://www.hindawi.com/journals/tswj/2014/843621/ (JIF 1.7) Open access. 

Findings presented at
Jordan S., Gabe M., Picek A. 2013 Adverse Drug Reactions at all ages: Everybody’s problem – whose job?

Invited presentations
Senedd, Cardiff Bay, Media briefing room 9.7.13 12.30-1.30. Invitation from Julie James Swansea West AM and Prof. Jonathan Bradbury (chair). 

Invitation to present inaugural seminar of the 2013/4 College of Medicine series. 18.9.13. ILS1. 

Jordan S., Gabe M., Picek A. 2013 Adverse Drug Reactions at all ages: Everybody’s problem – whose job? Invitation to present at Opan meeting 19.2.14