A new study led by Monash University has revealed the top ten signs and symptoms to monitor for that may help to identify adverse drug events in older people living in long-term care facilities who are using psychotropic medications such as antipsychotics, benzodiazepines and antidepressants.
Psychotropic medications are commonly used to manage a range of mental health conditions including depression, anxiety and insomnia. Older people who use this class of medicine often experience adverse events or side-effects which can lead to significant harm.
As such, monitoring for signs and symptoms suggestive of adverse drug events should be routine in long-term aged care facilities.
Researchers from the Centre for Medicine Use and Safety (CMUS), within the Monash Institute of Pharmaceutical Sciences (MIPS), have led a new international consensus study and found the top ten signs and symptoms to be recent falls, daytime drowsiness or sleepiness, abnormal movements, confusion or disorientation, balance problems, dizziness, postural hypotension (i.e. dizziness caused by low blood pressure when standing up), reduced self-care, restlessness, and dry mouth.
The study involved geriatricians, psychiatrists, clinical pharmacologists, general practitioners, pharmacists, nurses, and carers from 13 different Asia Pacific, European, and North American countries.
The study's lead author, CMUS PhD candidate and Monash Health pharmacist Brigid McInerney, said the top ten signs and symptoms identified by the international expert panel were considered to reduce quality of life or cause significant resident harm and were observable or measurable by nurses and care workers.
"Medication safety is a national health priority area – and residents of aged care facilities are at high risk of experiencing medication-related harm. Our findings will empower nurses and aged care workers to identify when residents are experiencing side-effects," she said.
CMUS has recently led the development of Australia's new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.
These Guidelines recommend that all residents who use an antipsychotic, benzodiazepine or antidepressant medication for changed behaviours in people living with dementia should have a structured adverse event monitoring protocol in place. This new international consensus study provides further guidance about which signs and symptoms nurses and aged care workers should proactively monitor for.
"Australia's new Guidelines recommend all health professionals involved in prescribing, dispensing or administering a psychotropic medication for a resident should be familiar with the adverse event monitoring protocol, and this protocol should be available to residents and their carers' as well," Ms McInerney said.
CMUS researchers have developed an adverse event monitoring tool, based on this study, for use by residential care nurses or care workers to detect signs and symptoms of adverse events in residents who use psychotropic medications.
"We anticipate that this short, easy-to-use checklist can be for routine use in different residential aged care facilities. This may facilitate proactive monitoring and early detection of adverse drug events and avoid further medication-related harm."
Psychotropic medicine safety is a key focus area for the Australian Government and CMUS. In May, a new national standard - Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard – was released by the Australian Commission on Safety and Quality in Healthcare to provide guidance to clinicians, healthcare services and consumers on the safe and appropriate use of psychotropic medicines. Reviewing benefits and harms of treatment, including presence of potential psychotropic-related adverse events, is a key component of this Clinical Care Standard.
The research report titled 'Top 10 Signs and Symptoms of Psychotropic Adverse Drug Events to Monitor in Long-Term Care Residents' is available at https://www.jamda.com/article/S1525-8610(24)00540-1/fulltext
