Pharmacy, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
BMJ Open Qual. 2020 Aug;9(3). doi: 10.1136/bmjoq-2020-000997.
Inappropriate use of psychotropic medications in the elderly, particularly those with dementia, is a critical safety and quality concern. This pilot quality improvement study used a novel Department of Veterans Affairs (VA) Psychotropic Drug Safety Initiative performance dashboard (PDSI dashboard) to implement a pharmacist-led intervention to improve psychotropic medication prescribing practices in a VA skilled nursing facility (SNF). While clinical dashboard data have become commonplace, literature describing successful implementation for improved clinical care is scant.
This study took place from November 2015 to February 2016 at a 112-bed VA SNF. A pharmacist used the PDSI dashboard to identify 'actionable' patients with potentially inappropriate psychotropic prescribing and then completed chart reviews to confirm clinical indications. The pharmacist provided recommendations to providers for dose reductions or deprescribing via in-person communication and notes written in the electronic medical record. SNF providers completed anonymous surveys about their experience in receiving recommendations.
Over a 5-month period, the PDSI dashboard identified 21 patients with potentially inappropriate psychotropic medication use, with approximately one new patient identified each week. Prescribing recommendations were accepted 66% of the time. All seven SNF providers reported that recommendations were helpful in improving their psychotropic prescribing practices.
The PDSI dashboard was efficient and effective in identifying patients at risk for inappropriate use of psychotropic medications. A clinical pharmacist was essential for implementing and communicating recommendations from the dashboard to providers.
老年人，尤其是痴呆患者，不恰当地使用精神药物是一个严重的安全和质量问题。本试点质量改进研究使用了一种新的退伍军人事务部（VA）精神药物安全倡议绩效仪表板（PDSI 仪表板），由药剂师主导干预，以改善退伍军人事务部熟练护理机构（SNF）中精神药物的处方实践。虽然临床仪表板数据已经很常见，但描述成功实施以改善临床护理的文献却很少。
本研究于 2015 年 11 月至 2016 年 2 月在一家拥有 112 张床位的退伍军人事务部 SNF 进行。药剂师使用 PDSI 仪表板来识别潜在不适当精神药物处方的“可采取行动”患者，然后完成图表审查以确认临床指征。药剂师通过面对面沟通和电子病历中的记录为提供者提供减少剂量或减药的建议。SNF 提供者完成了关于他们接受建议的匿名调查。
在 5 个月的时间里，PDSI 仪表板确定了 21 名潜在不适当精神药物使用的患者，每周大约有一名新患者被识别。处方建议的接受率为 66%。所有 7 名 SNF 提供者均报告称，建议有助于改善他们的精神药物处方实践。
PDSI 仪表板在识别有潜在不适当使用精神药物风险的患者方面是高效和有效的。临床药剂师对于实施和向提供者传达仪表板的建议至关重要。
