Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts, USA.
Department of Medicine & Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2023 Oct;71(10):3267-3277. doi: 10.1111/jgs.18564. Epub 2023 Aug 19.
Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study.
This was a non-randomized trial (pilot study) including NH staff and residents from five facilities. Long-stay residents at high-risk for injurious falls were identified using a validated risk calculator and staff referral. A remote team reviewed the electronic health record (EHR) and provided recommendations as Injury Prevention Plans (IPP). A research nurse served as a care coordinator focused on resident engagement and shared decision-making. Outcomes included implementation measures, as identified in the EHR, and surveys and interviews with staff.
Across five facilities, 274 residents were screened for eligibility, and 46 residents (16.8%) were enrolled. Most residents were female (73.9%) and had dementia (63.0%). An IPP was completed for 45 residents (97.8%). The nurse made a total of 93 deprescribing recommendations in 36 residents (80% of residents had one or more deprescribing recommendation; mean 2.2 recommendations/resident). Twenty of 45 residents (44.4%) had a recommendation for osteoporosis treatment. Among residents with recommendations, 21/36 (58.3%) had one or more deprescribing orders written and 6/20 (30.0%) had an osteoporosis medication prescribed. At 4 months, most medication changes persisted. Adverse side effects were rare. Staff members identified several areas for program refinement, including aligning recommendations with provider workflow and engaging consultant psychiatrists.
A remote injury prevention service is safe and feasible to enhance deprescribing and osteoporosis treatment in long-stay NH residents at risk for injury. Additional investigation is needed to determine if this model could reduce injurious falls when deployed across NH chains.
药物优化，包括骨质疏松症药物的处方和与跌倒相关的药物停用，可能会减少伤害性跌倒。我们的目的是描述一种远程的、预防伤害的服务（NH PRIDE），旨在优化养老院（NH）的药物使用，并在一项试点研究中描述其实施结果。
这是一项非随机试验（试点研究），包括来自五家机构的 NH 工作人员和居民。使用经过验证的风险计算器和工作人员推荐，确定有高伤害性跌倒风险的长期住院患者。一个远程团队审查电子健康记录（EHR）并提供作为伤害预防计划（IPP）的建议。一名研究护士担任护理协调员，专注于居民参与和共同决策。结果包括实施措施，这些措施在 EHR 中确定，并对工作人员进行调查和访谈。
在五家机构中，对 274 名居民进行了资格筛选，其中 46 名居民（16.8%）入组。大多数居民为女性（73.9%），患有痴呆症（63.0%）。为 45 名居民（97.8%）完成了 IPP。护士共在 36 名居民（80%的居民有一项或多项药物停用建议；平均每位居民 2.2 项建议）中提出了 93 项药物停用建议。45 名居民中有 20 名（44.4%）有骨质疏松症治疗建议。在有建议的居民中，36 名居民中有 21 名（58.3%）开出了一项或多项药物停用医嘱，20 名居民中有 6 名（30.0%）开出了骨质疏松症药物处方。在 4 个月时，大多数药物变化仍在继续。不良反应很少见。工作人员确定了几个计划改进的领域，包括使建议与提供者的工作流程保持一致以及让顾问精神科医生参与。
远程伤害预防服务是安全可行的，可以增强有受伤风险的长期住院 NH 居民的药物停用和骨质疏松症治疗。需要进一步研究以确定该模型在 NH 连锁机构中部署时是否可以减少伤害性跌倒。
