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Tytuł:
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'Real time' monitoring of antipsychotic prescribing in patients with dementia: a study using the Clinical Record Interactive Search (CRIS) platform to enhance safer prescribing.
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Autorzy:
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Colling C; Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Mueller C; Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK.; Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK.
Perera G; Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Funnell N; Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK.
Sauer J; Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK.; Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK.
Harwood D; Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK.
Stewart R; Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK.; Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK.
Bishara D; Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK .; Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK.
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Źródło:
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BMJ open quality [BMJ Open Qual] 2020 Mar; Vol. 9 (1).
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Original Publication: London : BMJ Publishing Group
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MeSH Terms:
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Antipsychotic Agents/*adverse effects
Dementia/*drug therapy
Monitoring, Physiologic/*instrumentation
Antipsychotic Agents/therapeutic use ; Electronic Health Records/statistics & numerical data ; Humans ; London ; Monitoring, Physiologic/trends ; State Medicine/organization & administration ; State Medicine/statistics & numerical data
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References:
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PLoS One. 2014 Sep 03;9(9):e105312. (PMID: 25184819)
BMJ Open. 2016 Mar 01;6(3):e008721. (PMID: 26932138)
Schizophr Bull. 2015 May;41(3):644-55. (PMID: 25154620)
BMJ Open. 2017 Jul 17;7(7):e015297. (PMID: 28716789)
Ann Intern Med. 2007 Jun 5;146(11):775-86. (PMID: 17548409)
Acta Psychiatr Scand. 2014 Aug;130(2):83-6. (PMID: 24730985)
BMJ Open. 2017 Jan 17;7(1):e012012. (PMID: 28096249)
PLoS One. 2013 Sep 12;8(9):e74262. (PMID: 24069288)
Int J Geriatr Psychiatry. 2014 Dec;29(12):1249-54. (PMID: 24633896)
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Grant Information:
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MC_PC_17214 United Kingdom MRC_ Medical Research Council; MR/T045302/1 United Kingdom MRC_ Medical Research Council
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Contributed Indexing:
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Keywords: checklists; clinical audit; continuous quality improvement; dementia; electronic health records
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Substance Nomenclature:
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0 (Antipsychotic Agents)
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Entry Date(s):
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Date Created: 20200402 Date Completed: 20201125 Latest Revision: 20230913
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Update Code:
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20240105
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PubMed Central ID:
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PMC7170541
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DOI:
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10.1136/bmjoq-2019-000778
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PMID:
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32229485
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Background: The use of antipsychotic drugs in dementia has been reported to be associated with increased risk of cerebrovascular events and mortality. There is an international drive to reduce the use of these agents in patients with dementia and to improve the safety of prescribing and monitoring in this area.
Objectives: The aim of this project was to use enhanced automated regular feedback of information from electronic health records to improve the quality of antipsychotic prescribing and monitoring in people with dementia.
Methods: The South London and Maudsley NHS Foundation Trust (SLaM) incorporated antipsychotic monitoring forms into its electronic health records. The SLaM Clinical Record Interactive Search (CRIS) platform provides researcher access to de-identified health records, and natural language processing is used in CRIS to derive structured data from unstructured free text, including recorded diagnoses and medication. Algorithms were thus developed to ascertain patients with dementia receiving antipsychotic treatment and to determine whether monitoring forms had been completed. We used two improvement plan-do-study-act cycles to improve the accuracy of the algorithm for automated evaluation and provided monthly feedback on team performance.
Results: A steady increase in antipsychotic monitoring form completion was observed across the study period. The percentage of our sample with a completed antipsychotic monitoring form more than doubled from October 2017 (22%) to January 2019 (58%).
Conclusion: 'Real time' monitoring and regular feedback to teams offer a time-effective approach, complementary to standard audit methods, to enhance the safer prescribing of high risk drugs.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
