Psychotropic medications are frequently used in long-term care facilities, but their adverse drug events (ADEs) pose significant risks to older adults. Effective monitoring tools are crucial for identifying and managing these ADEs to improve patient safety and outcomes. This article reviews the current landscape of monitoring tools specifically designed for psychotropic ADEs in long-term care settings, highlighting their characteristics, validity, and the need for future research in this critical area.
Overview of Existing Monitoring Tools for Psychotropic ADEs
A systematic review was conducted to evaluate the properties of psychotropic ADE monitoring tools intended for use in long-term care facilities. This review identified six distinct tools from eight studies conducted across various countries including Wales, United States, Ireland, Canada, and Singapore. These monitoring tools are designed to assess a range of items, from a focused set of 4 to a comprehensive list of 95, related to common psychotropic medication classes. Notably, all six tools included monitoring for antipsychotic-related ADEs, while antidepressants, benzodiazepines/hypnotics, and antiepileptics were monitored by four tools each. One tool also extended its scope to dementia medications.
The most frequently monitored ADEs across these tools included sedation, tiredness, or sleepiness, which were assessed by all six tools. Falls and tremor or extrapyramidal symptoms were also commonly monitored, each appearing in four of the tools. This highlights the clinical relevance of these specific ADEs in the context of psychotropic medication use in long-term care.
Key Features and Limitations of Monitoring Tools
The intended users and application of these monitoring tools vary. The majority, four out of six, were designed for use by nurses, reflecting their pivotal role in direct patient care in long-term care facilities. One tool was intended to be used during family conferences, suggesting an approach involving broader stakeholder input. Another tool was designed for use by general medical practitioners before repeat prescribing, indicating a focus on proactive medication review.
The time required to administer these tools also varied, with two tools reported to take between 10 to 60 minutes. In terms of validation, four tools were found to have adequate content validity, suggesting that they appropriately cover the relevant aspects of psychotropic ADEs. Two tools demonstrated adequate interrater reliability, indicating consistency in results when used by different raters. However, it’s important to note that none of the reviewed tools reported on test-retest reliability or construct validity, highlighting gaps in the comprehensive validation of these instruments.
Implications and Future Directions for ADE Monitoring in Long Term Care
The existing psychotropic ADE monitoring tools for long-term care are diverse in their design, scope, and intended application. Currently available tools are primarily geared towards use by nurses, either independently or as part of a wider multidisciplinary team approach. This review underscores the necessity for further investigation into optimal models of care that effectively integrate psychotropic ADE monitoring within the long-term care facility setting. Crucially, research is needed to determine the extent to which the application of these monitoring tools directly translates to a reduction in medication-related harm for residents in long-term care. Future efforts should focus on developing and validating robust, user-friendly monitoring tools and implementing them within effective models of care to enhance medication safety and improve the well-being of older adults in long-term care.
