Polypharmacy Adverse Drug Reactions (PADRe) Study
Research type
Research Study
Full title
Nurse-led intervention to minimise adverse drug reactions for older adults in care homes: a quality improvement process intervention \nPolypharmacy Adverse Drug Reactions (PADRe) Study\n
IRAS ID
237933
Contact name
Andrew Carson Stevens
Contact email
Sponsor organisation
Aneurin Bevan University Health Board
Duration of Study in the UK
1 years, 0 months, 18 days
Research summary
Some 5-8% of unplanned hospital admissions are attributed to largely preventable adverse drug reactions (NICE 2015), with polypharmacy often implicated, costing the NHS £1-2.5bn pa (Frontier Economics 2014). Our nurse-led instrument to monitor and review mental health medicines demonstrated improved care quality by: identifying serious adverse drug reactions (ADRs); reducing prescription of mental health medicines; reducing the prevalence of pain and nausea; and, increasing non-urgent NHS contacts with prescribers, dentists and opticians (Jordan et al 2015). \n\nFrom our analysis of polypharmacy-related reports in the National Reporting and Learning System and the literature, we are extending nurse-led medicines’ monitoring to include adverse signs and symptoms from other commonly prescribed drugs in older adults. This revised medicines’ monitoring instrument will undergo content validation by a multidisciplinary team, and cognitively tested with professionals and service users. \n\nThe intervention will be implemented in 7 care homes in Aneurin Bevan University Health Board. Private sector care home nurses will be trained to monitor residents for potential adverse effects of their medicines over 3-6 months. A process evaluation of implementation will seek to understand how and in what contexts the intervention is being used to achieve improvement.\n\nIn each care home, 26 residents prescribed >3 medicines will be asked to consent to researchers reviewing their clinical records, including completed medicines’ monitoring records. When nurses have identified a possible adverse drug reaction, medication monitoring records will be passed to either the pharmacist or GP depending on existing local agreements for dealing with such concerns. Outcomes, particularly clinical changes, will be monitored through record review before and after the intervention, with an intermediate check. We shall use serial debriefing interviews, nurses’ reflective logs, and wider stakeholder interviews (including GPs and pharmacists involved in routine care) to describe the processes of embedding, minimising adverse events, and barriers and facilitators of change. \n299 – max 300\nJordan S, Gabe-Walters ME, Watkins A, Humphreys I, Newson L, Snelgrove S, Dennis M. (2015) Nurse-Led Medicines’ Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. PLoS ONE 10(10): e0140203. doi:10.1371/journal.pone.0140203 http://dx.plos.org/10.1371/journal.pone.0140203\nNICE 2015. http://www.nice.org.uk/guidance/ng5/evidence/full-guideline-6775454\nFrontier Economic. Exploring the costs of unsafe care in the NHS: a report prepared for the department of health, Frontier Economics, London. 2014. Available at: http://www.frontier-economics.com/documents/2014/10/exploring-the-costs-of-unsafe-care-in-the-nhs-frontier-report-2-2-2-2.pdf (accessed 04 June 2015).\n
REC name
Wales REC 3
REC reference
17/WA/0391
Date of REC Opinion
27 Feb 2018
REC opinion
Further Information Favourable Opinion