Embedding a Quality Framework for medication safety standards in delirium and dementia: A Singapore Study in a geriatric psychiatry liaison service

Abstract

Introduction Research on prescribing processes for psychotropic medication review in older adult patients with severe behavioural symptoms of delirium and dementia appears limited. We aimed to improve and achieve 100% clinical documentation of psychotropic medication reviews against defined medication safety standards in older adult patients in geriatric wards with delirium occurrence and dementia without delirium referred to the geriatric psychiatry liaison service. The secondary aim evaluated any reduction in psychotropic medications as defined by medication safety standards by comparing pre-and post-assessments. Methods A baseline measurement in April 2022 showed no documentation records of the study’s first three standards. PDSA methodology was employed to evaluate whether a medication review occurred following the creation and implementation of medication safety standards 1 to 4 in cycle one and adding the fifth standard in cycle 2. The first, second and third standards were medication reviews of all hypnotics, antipsychotics, and psychotropic polypharmacy. The fourth standard reviewed the anticholinergic burden scores measured by the Anticholinergic Effect on Cognition scale. The fifth standard reviewed blood pressure and postural hypotension monitoring. Results Using a quality improvement framework that embeds defined medication safety standards as an intervention, we have demonstrated good documentation records for a medication review to improve psychotropic prescribing processes in the older adult’s psychiatry liaison service in geriatric wards in all standards in the 2 study cycles. There was a reduction in all psychotropic medications at post-assessment as defined by the medication safety standards 1 to 4 in at least one cycle in delirium occurrence and dementia without delirium, except for zopiclone in delirium. Conclusions The study’s findings in a geriatric ward setting in a public hospital in Singapore support the feasibility of embedding medication review using defined medication safety standards to improve psychotropic medication prescribing processes in older adults with delirium occurrence and dementia without delirium.